Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography.
OBJECTIVE
We evaluated the influence of heart rate on image quality and diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography.


BACKGROUND
Multidetector computed tomography (MDCT) coronary angiography has demonstrated an inverse relationship between heart rate and image quality. Dual-source CT provides a higher temporal resolution.


METHODS
One hundred patients were studied by DSCT (DEFINITION, Siemens Medical Solutions, Forchheim, Germany). A contrast-enhanced volume dataset was acquired (two tubes, 120 kV, 400 mAs/rot, collimation 64 x 0.6 mm). Datasets were evaluated concerning the presence of significant coronary stenoses and validated against invasive coronary angiography.


RESULTS
In 44 patients with a heart rate > or =65 beats/min, 566 of 616 coronary segments were evaluable (92%), whereas in 56 patients with a heart rate <65 beats/min, 777 of 778 coronary segments were evaluable (100%, p < 0.001). On a per-patient basis, 93% of patients (> or =65 beats/min) and 100% of patients (<65 beats/min) were considered evaluable. By classifying unevaluable segments as positive for stenosis, per-patient sensitivity was 95% (19 of 20) for heart rates > or =65 beats/min and 100% (22 of 22) for heart rates <65 beats/min. Specificity was 87% (21 of 24) versus 76% (26 of 34), and overall diagnostic accuracy was 91% (40 of 44) versus 86% (48 of 56). None of these differences were statistically significant. Similarly, no difference in diagnostic accuracy was found in per-vessel and -segment analyses.


CONCLUSIONS
In 100 patients studied without beta-blocker pre-medication, DSCT demonstrated slightly lower per-segment evaluability for high heart rates but no decrease in diagnostic accuracy for the detection of coronary artery stenoses.
D000368:Aged; D000465:Algorithms; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol