title: The influence of clinical and acquisition parameters on the interpretability of adenosine stress myocardial computed tomography perfusion.
abstract: OBJECTIVE
  The interpretation of adenosine stress myocardial computed tomography perfusion (CTP) is often hampered by image artefacts caused by cardiac motion, beam hardening, and cone beam. The aim of the present analysis was to assess the influence of the heart-rate response during adenosine infusion, patient characteristics, and medication use on the interpretability of stress myocardial CTP examinations.
  
  
  RESULTS
  Interpretability of stress myocardial CTP examinations was evaluated in 120 patients who underwent sequentially coronary CTA and adenosine stress myocardial CTP (320-row CT scanner, temporal resolution 175 ms) and scored as follows: excellent = absence of any artefact (n = 27, 22%); good = presence of artefacts that do not interfere with the study interpretability (n = 56, 47%); fair = artefacts that do interfere with interpretability (n = 35, 29%); poor = uninterpretable study due to artefacts (n = 2, 2%). 'Fair' and 'poor' were merged into 'reduced' for comparisons. Increasing heart rate during stress myocardial CTP acquisition was related to worse interpretability (excellent: 61.7 ± 13.4 bpm vs. good: 69.8 ± 13.5 bpm vs. reduced: 78.1 ± 17.0 bpm, P < 0.001). Thirteen (11%) of all examinations were considered non-diagnostic. In patients with a heart rate exceeding 85 bpm, 76% of the studies were 'reduced' interpretable. In multivariate analysis, no use of beta blocker (baseline or additional use prior to coronary CTA) (OR: 0.2, P = 0.012), increasing heart rate during coronary CTA (OR: 1.09, P = 0.032), younger age (OR: 0.92, P = 0.021), and the use of calcium antagonist (OR: 6.48, P = 0.017) were independently associated with a heart rate ≥85 bpm during stress myocardial CTP.
  
  
  CONCLUSIONS
  Higher heart rate during the acquisition of stress myocardial CTP was related to worse interpretability. Furthermore, increasing heart rate during and no beta blocker use prior to the previously performed coronary CTA, younger age, and the use of calcium antagonist were independently associated with a heart rate ≥85 bpm during stress myocardial CTP acquisition.
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.|The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: van Rosendael
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.
authors.forename: Michiel A
authors.initials: MA
authors.lastname: de Graaf
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.
authors.forename: Aukelien C
authors.initials: AC
authors.lastname: Dimitriu-Leen
authors.affiliation: Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.
authors.forename: Inge J
authors.initials: IJ
authors.lastname: van den Hoogen
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Kharbanda
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Lucia J
authors.initials: LJ
authors.lastname: Kroft
authors.affiliation: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden 2333 ZA, The Netherlands a.j.h.a.scholte@lumc.nl.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
mesh_terms: D000241:Adenosine; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005080:Exercise Test / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000241:Adenosine
keywords: CT myocardial perfusion; coronary CTA; image quality; imaging