title: Non-invasive coronary angiography with multislice spiral computed tomography: impact of heart rate.
abstract: OBJECTIVE
  To evaluate the impact of heart rate on the diagnostic accuracy of coronary angiography by multislice spiral computed tomography (MSCT).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  78 patients who underwent both conventional and MSCT coronary angiography for suspicion of de novo coronary artery disease (n=53) or recurrent coronary artery disease after percutaneous intervention (n=25).
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  Intravenously contrast enhanced MSCT coronary angiography was done during a single breath hold, and ECG synchronised images were reconstructed retrospectively. All coronary segments of > or = 2.0 mm without stents were evaluated by two investigators and compared with quantitative coronary angiography. Patients were classified according to the average heart rate (mean (SD)) into three equally sized groups: group 1, 55.8 (4.1) beats/min; group 2, 66.6 (2.8) beats/min; group 3, 81.7 (8.8) beats/min.
  
  
  RESULTS
  Image quality was sufficient for analysis in 78% of the coronary segments in patients in group 1, 73% in group 2, and 54% in group 3 (p < 0.01). The sensitivity and specificity for detecting significant stenoses (> or = 50% lumen reduction) in these assessable segments were: 97% (95% confidence interval (CI) 84% to 100%) and 96% in group 1; 74% (52% to 89%) and 94% in group 2; and 67% (33% to 90%) and 94% in group 3 (p < 0.05). Accounting for all segments of > or = 2.0 mm, including lesions in non-assessable segments as false negatives, the sensitivity decreased to 82% (28/34 lesions, 95% CI 69% to 91%), 61% (14/23 lesions, 42% to 77%), and 32% (6/19 lesions, 15% to 50%), respectively (p < 0.01).
  
  
  CONCLUSIONS
  MSCT allows reliable coronary angiography in patients with low heart rates.
authors.affiliation: Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands. koennieman@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Nieman
authors.forename: B J
authors.initials: BJ
authors.lastname: Rensing
authors.forename: R-J M
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: J
authors.initials: J
authors.lastname: Vos
authors.forename: P M T
authors.initials: PM
authors.lastname: Pattynama
authors.forename: G P
authors.initials: GP
authors.lastname: Krestin
authors.forename: P W
authors.initials: PW
authors.lastname: Serruys
authors.forename: P J
authors.initials: PJ
authors.lastname: de Feyter
mesh_terms: D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards