title: Diagnostic performance of prospectively ECG triggered versus retrospectively ECG gated 64-slice computed tomography coronary angiography in a heterogeneous patient population.
abstract: OBJECTIVE
  To compare diagnostic performance and applicability of prospectively versus retrospectively gated 64-slice computed tomography coronary angiography (pro-CTCA vs. retro-CTCA) in a heterogeneous patient population compared to invasive coronary angiography.
  
  
  METHODS
  77 patients referred to an ECG-gated-CT of the chest were retrospectively included. Pro-CTCA was applied, whenever possible, alternatively retro-CTCA was performed. All coronary artery segments≥1.5 mm were analysed and image quality was assessed.
  
  
  RESULTS
  In 39 patients retro-CTCA and in 38 patients pro-CTCA was applied, mean heart rate (HR) was 69.5±9.1 min(-1) and 62.8±5.9, respectively. For a stenosis≥50% segment-based (patient-based) analysis revealed a sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of 97%, 98%, 71%, 100% (91%, 82%, 67%, 96%) using retro-CTCA and 94%, 97%, 75%, 99% (93%, 96%, 93%, 96%) using pro-CTCA. Sensitivity and NPV increased in the pro-CTCA group in patients with a HR<65. Vessel-based analysis showed lower diagnostic performance for the right coronary artery (RCA) using pro-CTCA, which increased when HR<65. Image quality did not differ significantly in both groups.
  
  
  CONCLUSIONS
  Prospectively triggered CTCA in a heterogeneous patient group has a very high diagnostic accuracy and image quality, when used in HR≤65. A low HR is of special importance for the evaluation of the RCA.
authors.affiliation: University of Leipzig-Heart Center, Department of Diagnostic and Interventional Radiology, Strümpellstraße 39, D-04289 Leipzig, Germany. lukas.lehmkuhl@med.uni-leipzig.de
authors.forename: Lukas
authors.initials: L
authors.lastname: Lehmkuhl
authors.forename: Franziska
authors.initials: F
authors.lastname: Herz
authors.forename: Borek
authors.initials: B
authors.lastname: Foldyna
authors.forename: Hans Dieter
authors.initials: HD
authors.lastname: Nagel
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Stefan
authors.initials: S
authors.lastname: Nitzsche
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
mesh_terms: D000368:Aged; D055424:Cardiac-Gated Imaging Techniques; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*