title: Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy.
abstract: OBJECTIVE
  The aim of this study was to assess the impact of heart rate, heart rate variability and calcification on image quality and diagnostic accuracy in an unselected patient collective.
  
  
  METHODS
  One hundred and two consecutive patients with known or suspected coronary artery disease underwent both 64-MSCT and invasive coronary angiography. Image quality (IQ) was assessed by independent observers using a 4-point scale from excellent (1) to non-diagnostic (4). Accuracy of MSCT regarding detection or exclusion of significant stenosis (>50%) was evaluated on a per segment basis in a modified AHA 13-segment model. Effects of heart rate, heart rate variability, calcification and body mass index (BMI) on IQ and accuracy were evaluated by multivariate regression. IQ and accuracy were further analysed in subgroups of significant predictor variables and simple regression performed to calculate thresholds for adequate IQ.
  
  
  RESULTS
  Mean heart rate was 68.2+/-13.3 bpm, mean heart rate variability 11.5+/-16.0 beats per CT-examination (bpct) and median Agatston score 226.5. Average IQ score was 2+/-0.6 whilst diagnostic quality was obtained in 89% of segments. Overall sensitivity, specificity, PPV or NPV was 91.2%, 99.2%, 95.3% or 98.3%. According to multivariate regression, overall IQ was significantly related to heart rate and calcification (P=0.0038; P<0.0001). The effect of heart rate variability was limited to IQ of RCA segments (P=0.018); BMI was not related to IQ (P=0.52). Calcification was the only predictor variable with significant effect on the number of non-diagnostic segments (P<0.0001). In a multivariate regression, calcification was also the single factor with impact on diagnostic accuracy (P=0.0049).
  
  
  CONCLUSIONS
  Whilst heart rate, heart rate variability and calcification all show an inverse correlation to IQ, severe calcium burden remains the single factor with translation of such effect into decrease of diagnostic accuracy.
authors.affiliation: Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany. h.brodoefel@t-online.de
authors.forename: H
authors.initials: H
authors.lastname: Brodoefel
authors.forename: A
authors.initials: A
authors.lastname: Reimann
authors.forename: C
authors.initials: C
authors.lastname: Burgstahler
authors.forename: F
authors.initials: F
authors.lastname: Schumacher
authors.forename: T
authors.initials: T
authors.lastname: Herberts
authors.forename: I
authors.initials: I
authors.lastname: Tsiflikas
authors.forename: S
authors.initials: S
authors.lastname: Schroeder
authors.forename: C D
authors.initials: CD
authors.lastname: Claussen
authors.forename: A F
authors.initials: AF
authors.lastname: Kopp
authors.forename: M
authors.initials: M
authors.lastname: Heuschmid
mesh_terms: D015992:Body Mass Index; D002114:Calcinosis / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D036542:Tomography, Spiral Computed
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol