Improving diagnostic accuracy of MDCT coronary angiography in patients with mild heart rhythm irregularities using ECG editing.
OBJECTIVE
The objective of our study was to compare diagnostic accuracy of MDCT coronary angiography in a population of patients with mild heart rhythm irregularities before and after editing the ECG.


METHODS
Thirty-eight patients who underwent MDCT coronary angiography and conventional coronary angiography were enrolled in the study. The inclusion criterion was the presence of mild heart rhythm irregularities (i.e., premature beats; atrial fibrillation; mistriggering; or low heart rate, defined as 40 beats per minute or less) during the scan. All patients underwent MDCT with the following parameters: 16 detectors; collimation, 0.75 mm; gantry rotation time, 375 msec; 120 kV; and effective milliampere-second setting, 500-600. Images were reconstructed in two settings: before ECG editing and after ECG editing (i.e., arbitrary modification of temporal windows within the cardiac cycle at the site of mild heart rhythm irregularities). Data sets were scored for the presence of significant stenoses (> or = 50% lumen reduction) in coronary segments > or = 2 mm diameter. The results of the two groups were compared with a McNemar test, and a p value of less than 0.05 was considered significant.


RESULTS
The sensitivity, specificity, and negative and positive predictive values of MDCT coronary angiography for the detection of significant stenoses before and after ECG editing were 63% (41/65) and 92% (78/85); 97% (251/260) and 96% (305/317); 87% (62/71) and 87% (81/93); 91% (251/275) and 97% (305/313), respectively (p < 0.05). The proportion of nonassessable segments was reduced from 17% (70/416) before ECG editing to 2% (10/416) after.


CONCLUSIONS
ECG editing significantly improves diagnostic accuracy in a selected population of patients with mild heart rate irregularities.
Department of Radiology, Erasmus Medical Center, Dr. Molewaterplein, 40, Rotterdam 3015GD, The Netherlands. filippocademartiri@hotmail.com
Filippo
F
Cademartiri
Nico R
NR
Mollet
Giuseppe
G
Runza
Timo
T
Baks
Massimo
M
Midiri
Eugene P
EP
McFadden
Thomas G
TG
Flohr
Bernd
B
Ohnesorge
Pim J
PJ
de Feyter
Gabriel P
GP
Krestin
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging*; D001919:Bradycardia / Q000000981:diagnostic imaging*; D005117:Cardiac Complexes, Premature / Q000000981:diagnostic imaging*; D003287:Contrast Media; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol