title: Prospectively ECG-Triggered Sequential Dual-Source Coronary CT Angiography in Patients with Atrial Fibrillation: Influence of Heart Rate on Image Quality and Evaluation of Diagnostic Accuracy.
abstract: OBJECTIVE
  To evaluate the effects of mean heart rate (HR) and heart rate variation (HRV) on image quality and diagnostic accuracy of prospectively ECG-triggered sequential dual-source coronary CT angiography (CCTA) in patients with atrial fibrillation (AF).
  
  
  METHODS
  Eighty-five patients (49 women, 36 men; mean age 62. 1 ± 9.5 years) with persistent AF underwent prospectively ECG-triggered sequential second-generation dual-source CCTA. Tube current and voltage were adjusted according to body mass index (BMI) and iterative reconstruction was used. Image quality of coronary segments (four-point scale) and presence of significant stenosis (>50%) were evaluated. Diagnostic accuracy was analyzed in 30 of the 85 patients who underwent additional invasive coronary angiography (ICA).
  
  
  RESULTS
  Only 8 of 1102 (0.7%) segments demonstrated poor image quality. No significant impact on image quality was found for mean HR (94.9 ± 21.8 bpm; r=0.034, p=0.758; F=0.413, p=0.663) or HRV (67.5 ± 22.8 bpm; r=0.097, p=0.377; F=0.111, p=0.895). On per-segment analysis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 89.7% (26/29), 99.4% (355/357), 92.9% (26/28), and 99.2% (355/358), respectively, with excellent correlation (kappa=0.91) with ICA. Mean effective dose was 3.3 ± 1.0 mSv.
  
  
  CONCLUSIONS
  Prospectively ECG-triggered sequential dual-source CCTA provides diagnostic image quality and good diagnostic accuracy for detection of coronary stenosis in AF patients without significant influence by HR or HRV.
authors.affiliation: Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fox
authors.affiliation: Siemens Healthcare China, 278 Zhouzhu Road, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhanming
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhaoqi
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*