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Updated: Feb 16, 2026
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Influence of heart rate on coronary calcium scores: a multi-manufacturer phantom study
N R van der Werf1,2,3,4, M J Willemink5, T P Willems6
1Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. n.r.vanderwerf@umcutrecht.nl.
Insights
Elevated heart rates significantly impact coronary calcium scores (CCS) on advanced CT scanners, increasing scores for medium and high calcifications. CT systems show varying susceptibility to heart rate motion, emphasizing consistent scan protocols for follow-ups.
Area of Science:
- Medical Imaging
- Cardiovascular Imaging
- Radiology
Background:
- Coronary calcium scoring (CCS) is crucial for cardiovascular risk assessment.
- Heart rate variability can influence the accuracy of CCS measurements.
- High-end computed tomography (CT) systems are widely used for CCS evaluation.
Purpose of the Study:
- To assess the impact of varying heart rates on CCS.
- To compare the performance of four different high-end CT systems regarding heart rate influence.
- To quantify the motion susceptibility of CT systems during CCS acquisition.
Main Methods:
- A dynamic phantom with artificial coronary arteries was used to simulate different heart rates (<60, 60-75, >75 bpm).
- Data was acquired on four high-end CT systems (CT1-CT4) using standard CCS protocols.
- Coronary calcium scores (Agatston and mass) were compared to a reference (<60 bpm), and cardiac motion susceptibility (CMS) index was calculated.
Main Results:
- At heart rates >75 bpm, Agatston scores for medium and high calcifications increased up to 50% across all tested CT systems.
- A threefold increase in CMS was observed at >75 bpm compared to <60 bpm.
- Significant differences in CMS were found between CT systems for medium and high calcifications.
Conclusions:
- Heart rate substantially influences CCS accuracy on high-end CT systems from major manufacturers.
- CT systems exhibit varying degrees of susceptibility to cardiac motion.
- Consistent follow-up CCS scans require using the same CT system, protocol, and comparable heart rates.
Abstract:
To evaluate the influence of heart rate on coronary calcium scores (CCS) using a dynamic phantom on four high-end computed tomography (CT) systems from different manufacturers. Artificial coronary arteries were moved in an anthropomorphic chest phantom at linear velocities, corresponding to < 60, 60-75 and > 75 beats per minute (bpm). Data was acquired with routinely used clinical protocols for CCS on four high-end CT systems (CT1-CT4). CCS, quantified as Agatston and mass scores were compared to reference scores at < 60 bpm. Influence of heart rate was assessed for each system with the cardiac motion susceptibility (CMS) Index. At increased heart rates (> 75 bpm), Agatston scores of the low mass calcification were similar to the reference score, while Agatston scores of the medium and high mass calcification increased significantly up to 50% for all CT systems. Threefold CMS increases at > 75 bpm in comparison with < 60 bpm were shown. For medium and high mass calcifications, significant differences in CMS between CT systems were found. Heart rate substantially influences CCS for high-end CT systems of four major manufacturers, but CT systems differ in motion susceptibility. Follow-up CCS CT scans should be acquired on the same CT system and protocol, and preferably with comparable heart rates.
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