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The influence of clinical and acquisition parameters on the interpretability of adenosine stress myocardial computed
Alexander R van Rosendael1,2, Michiel A de Graaf1, Aukelien C Dimitriu-Leen1
1Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.
Insights
Higher heart rates during adenosine stress myocardial computed tomography perfusion (CTP) examinations correlate with reduced image interpretability. Factors like no beta-blocker use and calcium antagonist use are linked to increased heart rates during CTP.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Adenosine stress myocardial computed tomography perfusion (CTP) is crucial for assessing coronary artery disease.
- Image artifacts, particularly from cardiac motion, often compromise CTP interpretability.
- Understanding factors influencing CTP quality is vital for accurate diagnosis.
Purpose of the Study:
- To evaluate the impact of heart rate during adenosine infusion on stress myocardial CTP interpretability.
- To identify patient characteristics and medications associated with heart rate response during CTP.
- To improve the diagnostic accuracy of stress myocardial CTP.
Main Methods:
- 120 patients underwent coronary computed tomography angiography (CTA) followed by adenosine stress myocardial CTP.
- CTP images were scored for interpretability based on artifact presence and severity.
- Multivariate analysis identified factors associated with heart rate during CTP acquisition.
Main Results:
- Increased heart rate during stress CTP was significantly associated with reduced image interpretability (P < 0.001).
- 11% of all CTP examinations were deemed non-diagnostic due to artifacts.
- A heart rate exceeding 85 bpm during CTP was linked to 'reduced' interpretability in 76% of cases.
- No beta-blocker use, younger age, and calcium antagonist use were independently associated with heart rates ≥85 bpm.
Conclusions:
- Elevated heart rate during adenosine stress myocardial CTP acquisition negatively impacts image quality and interpretability.
- Proactive management of heart rate, considering patient factors and medications, may enhance CTP diagnostic yield.
- Further research into artifact reduction strategies for CTP is warranted.
Aims:
The interpretation of adenosine stress myocardial computed tomography perfusion (CTP) is often hampered by image artefacts caused by cardiac motion, beam hardening, and cone beam. The aim of the present analysis was to assess the influence of the heart-rate response during adenosine infusion, patient characteristics, and medication use on the interpretability of stress myocardial CTP examinations.
Methods And Results:
Interpretability of stress myocardial CTP examinations was evaluated in 120 patients who underwent sequentially coronary CTA and adenosine stress myocardial CTP (320-row CT scanner, temporal resolution 175 ms) and scored as follows: excellent = absence of any artefact (n = 27, 22%); good = presence of artefacts that do not interfere with the study interpretability (n = 56, 47%); fair = artefacts that do interfere with interpretability (n = 35, 29%); poor = uninterpretable study due to artefacts (n = 2, 2%). 'Fair' and 'poor' were merged into 'reduced' for comparisons. Increasing heart rate during stress myocardial CTP acquisition was related to worse interpretability (excellent: 61.7 ± 13.4 bpm vs. good: 69.8 ± 13.5 bpm vs. reduced: 78.1 ± 17.0 bpm, P < 0.001). Thirteen (11%) of all examinations were considered non-diagnostic. In patients with a heart rate exceeding 85 bpm, 76% of the studies were 'reduced' interpretable. In multivariate analysis, no use of beta blocker (baseline or additional use prior to coronary CTA) (OR: 0.2, P = 0.012), increasing heart rate during coronary CTA (OR: 1.09, P = 0.032), younger age (OR: 0.92, P = 0.021), and the use of calcium antagonist (OR: 6.48, P = 0.017) were independently associated with a heart rate ≥85 bpm during stress myocardial CTP.
Conclusion:
Higher heart rate during the acquisition of stress myocardial CTP was related to worse interpretability. Furthermore, increasing heart rate during and no beta blocker use prior to the previously performed coronary CTA, younger age, and the use of calcium antagonist were independently associated with a heart rate ≥85 bpm during stress myocardial CTP acquisition.
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