Impact of heart rate frequency and variability on radiation exposure, image quality, and diagnostic performance in dual-source spiral CT coronary angiography

Annick C Weustink, Lisanne A Neefjes, Stamatis Kyrzopoulos, Marcel van Straten, Rick Neoh Eu, Willem B Meijboom, Carlos A van Mieghem, Ermanno Capuano, Marcel L Dijkshoorn, Filippo Cademartiri, Eric Boersma, Pim J de Feyter, Gabriel P Krestin, Nico R Mollet
Radiology 2009, 253 (3): 672-80

PURPOSE: To investigate the effect of heart rate frequency (HRF) and heart rate variability (HRV) on radiation exposure, image quality, and diagnostic performance to help detect significant stenosis (> or =50% lumen diameter reduction) by using adaptive electrocardiographic (ECG) pulsing at dual-source (DS) spiral computed tomographic (CT) coronary angiography.

MATERIALS AND METHODS: Institutional review committee approval and informed consent were obtained. No prescan beta-blockers were applied. Unenhanced CT and CT coronary angiography with adaptive ECG pulsing were performed in 927 consecutive patients (600 men, 327 women; mean age, 60.3 years +/- 11.0 [standard deviation]) divided in three HRF groups: low, intermediate, and high (< or =65, 66-79, and > or =80 beats/min, respectively), and four HRV groups given mean interbeat difference (IBD) during CT coronary angiography: normal, minor, moderate, and severe (IBDs of 0-1, 2-3, 4-10, and >10, respectively). Radiation exposure and image quality were also evaluated. In 444 of these, diagnostic performance was presented as sensitivity, specificity, positive predictive values (PPVs), and negative predictive values and likelihood ratios with corresponding 95% confidence intervals by using quantitative coronary angiography as the reference standard.

RESULTS: CT coronary angiography yielded good image quality in 98% of patients and no significant differences in image quality were found among HRF and HRV groups. Radiation exposure was significantly higher in patients with low versus high HRF and in patients with severe versus normal HRV. No significant differences among HRF and HRV groups in image quality and diagnostic performance were found. A nonsignificant trend was found toward a lower specificity and PPV in patients with a high HRF or severe HRV when compared with low HRF or normal HRV in patients with a low calcium score (Agatston score <100).

CONCLUSION: DS spiral CT coronary angiography performed with adaptive ECG pulsing results in preserved diagnostic image quality and performance independent of HRF or HRV at the cost of limited dose reduction in arrhythmic patients.

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