title: Dual-step prospective ECG-triggered 128-slice dual-source CT for evaluation of coronary arteries and cardiac function without heart rate control: a technical note.
abstract: OBJECTIVE
  To describe prospective ECG-triggered dual-source CT dual-step pulsing (pECG(dual_step)) for evaluation of coronary arteries and cardiac function.
  
  
  METHODS
  Fifty-one consecutive patients pre- or post-cardiovascular surgery were examined with adaptive sequential tube current modulated (pECG(dual-step)) 128-slice dual-source CT without heart rate control (main padding window: 40% RR interval >65 bpm/70% RR interval <65 bpm). Image quality of coronary arteries was graded (4-point scale), and cardiac function was evaluated.
  
  
  RESULTS
  Mean HR was 68 bpm. Thirty-seven patients were in stable sinus rhythm (SR); 14 had arrhythmia. Image quality of coronary arteries was diagnostic in 804/816 (98%) of segments. The number of non-diagnostic segments was higher in patients with arrhythmia as compared to those in SR (4% vs. 0.5%; p = 0.01), and there were fewer segments with excellent image quality (79% vs. 94%; p < 0.001) and more segments with impaired image quality (p < 0.001 and p = 0.002). Global and regional LV function could be evaluated in 41 (80%) and 47 (92%) patients, and valvular function in 48 (94%). In 11/14 of patients with arrhythmia, the second step switched to full mAs, increasing radiation exposure to 8.6 mAs (p < 0.001). The average radiation dose was 3.8 mSv (range, 1.7-7.9) in patients in SR.
  
  
  CONCLUSIONS
  pECG(dual-step)128-slice DSCT is feasible for the evaluation of coronary arteries and cardiac function without heart rate control in patients in stable sinus rhythm at a low radiation dose.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland. gudrun.feuchtner@i-med.ac.at
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Robert
authors.initials: R
authors.lastname: Goetti
authors.forename: Andrè
authors.initials: A
authors.lastname: Plass
authors.forename: Stephan
authors.initials: S
authors.lastname: Baumueller
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Monika
authors.initials: M
authors.lastname: Wieser
authors.forename: Borut
authors.initials: B
authors.lastname: Marincek
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*
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