title: Demonstration of value of optimizing ECG triggering for cardiovascular magnetic resonance in patients with congenital heart disease.
abstract: BACKGROUND
  Optimal ECG triggering is of paramount importance for correct blood flow quantification during cardiovascular magnetic resonance (CMR). However, optimal ECG triggering and therefore blood flow quantification is impaired in many patients with congenital heart disease (CHD) due to complex QRS patterns. Therefore, a new ECG-trigger algorithm was developed to address triggering problems due to complex QRS patterns.The aim of this study was to test this new ECG-trigger algorithm in routine patients with CHD and its impact on blood flow quantification.
  
  
  METHODS
  35 consecutive routine patients with CHD undergoing CMR were included in the study. (40% Fallot's Tetralogy, 20% aortic arch pathology, 14% transposition of the great arteries, 26% others; age 26+/-11 yrs).In all patients, blood flow in the ascending aorta was quantified using the old ECG-trigger algorithm and the new ECG-trigger algorithm in random order. Blood flow quantified using the old or new ECG-trigger algorithm was compared by Bland-Altman analysis.Three blinded investigators evaluated the vector clouds and trigger points of both ECG-trigger methods. Evaluation criteria were false positive and false negative triggered QRS complexes (specificity and sensitivity), and accuracy of detection. Accuracy of detection was defined as time scatter of the trigger around the correct trigger point.
  
  
  RESULTS
  Specificity, sensitivity, and accuracy of detection significantly increased using the new ECG-trigger algorithm compared to the old ECG-trigger algorithm.Blood flow quantification using the old or new ECG-trigger algorithm differed more than 5% in 31% of the cases.
  
  
  CONCLUSIONS
  Our results suggest that optimizing ECG triggering during CMR using our new algorithm can avoid errors of >5% in approximately 1/3 of routine patients with congenital heart disease (CHD). We furthermore suggest that incorrect ECG triggering appears to be problematic for blood flow quantification of many patients with CHD undergoing routine CMR.
authors: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Klinikum an der Technischen Universität München, Lazarettstrasse 36, Munich, Germany.
authors: Thomas
authors: T
authors: Knesewitsch
authors: Christian
authors: C
authors: Meierhofer
authors: Henrike
authors: H
authors: Rieger
authors: Jürgen
authors: J
authors: Rößler
authors: Michael
authors: M
authors: Frank
authors: Stefan
authors: S
authors: Martinoff
authors: John
authors: J
authors: Hess
authors: Heiko
authors: H
authors: Stern
authors: Sohrab
authors: S
authors: Fratz
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001783:Blood Flow Velocity; D002648:Child; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D055815:Young Adult