title: Diagnostic accuracy of multislice computed tomography coronary angiography is improved at low heart rates.
abstract: OBJECTIVE
  Assess the effect of heart rate on diagnostic accuracy for the detection of significant coronary artery stenosis using 16-row multislice computed tomography (MSCT).
  
  
  METHODS
  About 120 patients (105 males; 59+/-11 years) with suspected coronary artery disease who underwent conventional coronary angiography (CA) and MSCT-CA were retrospectively enrolled for the study. Patients underwent a MSCT-CA (Sensation 16, Siemens, Germany), with the following protocol: collimation 16 x 0.75 mm, gantry rotation time 420 ms, feed/rotation 3.0 mm, kV 120, mAs 400-500. The protocol for contrast material administration was 100 ml of Iodixanol (Visipaque 320 mg l/ml, Amersham, UK) at 4 ml/s and the delay was defined with a bolus tracking technique. In all patients the mean heart rate (HR) during the scan was used as a criteria to divide the population in two groups of 60 patients each. In one group (Low HR) the 60 patients with lower heart rates, and in the other group (High HR) the patients with higher heart rates. In the two groups diagnostic accuracy (per coronary segment) for the detection of significant stenosis (>or=50% lumen reduction) was evaluated in vessels >or=2 mm of diameter using quantitative CA as reference standard. The difference in diagnostic accuracy were compared with a Chi(2) test and a p<0.05 was considered significant.
  
  
  RESULTS
  There was no significant difference between the two groups regarding age, gender, weight, mean intravascular attenuation, and calcium score. Overall 1,310 (652 for Low HR and 658 for High HR) segments with 219 (105 for Low HR and 114 for High HR) significant lesions were available for the analysis. The average heart rate was 52+/-4 HU and 63+/-5 HU for Low HR and High HR, respectively (p<0.001). The sensitivity and specificity were 92 and 96% for Low HR and 90 and 92% for High HR (p<0.05). There were 22 vs. 44 false positives, and 8 vs. 12 false negatives in the Low HR and High HR, respectively.
  
  
  CONCLUSIONS
  Increasing HR significantly deteriorates diagnostic accuracy in MSCT-CA.
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. filippocademartiri@hotmail.com
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Nico R
authors.initials: NR
authors.lastname: Mollet
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Runza
authors.forename: Manuel
authors.initials: M
authors.lastname: Belgrano
authors.forename: Patrizia
authors.initials: P
authors.lastname: Malagutti
authors.forename: Bob W
authors.initials: BW
authors.lastname: Meijboom
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.forename: Pim J de
authors.initials: PJ
authors.lastname: Feyter
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
mesh_terms: D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol