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CLINICAL RESEARCH: CARDIAC IMAGING

Influence of Heart Rate on the Diagnostic Accuracy of Dual-Source Computed Tomography Coronary Angiography

Ulrike Ropers, MD^_*, Dieter Ropers, MD^_*, Tobias Pflederer, MD^_*, Katharina Anders, MD, Axel Kuettner, MD, Nikolaos I. Stilianakis, MD^,||, Sei Komatsu, MD^_*, Willi Kalender, MD, Werner Bautz, MD, Werner G. Daniel, MD, FACC^_* and Stephan Achenbach, MD, FACC^_*,_*

^_* Department of Internal Medicine 2 (Cardiology–Angiology), University of Erlangen-Nuremberg, Erlangen, Germany
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
Institute of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Germany
Department of Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
^|| Joint Research Centre, European Commission, Ispra (Va), Italy.

Manuscript received June 18, 2007; revised manuscript received August 16, 2007, accepted September 10, 2007.

^_* Reprint requests and correspondence: Dr. Stephan Achenbach, Department of Cardiology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany. (Email: stephan.achenbach{at}uk-erlangen.de).

Objectives: We evaluated the influence of heart rate on image quality and diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography.

Background: Multidetector computed tomography (MDCT) coronary angiography has demonstrated an inverse relationship between heart rate and image quality. Dual-source CT provides a higher temporal resolution.

Methods: One hundred patients were studied by DSCT (DEFINITION, Siemens Medical Solutions, Forchheim, Germany). A contrast-enhanced volume dataset was acquired (two tubes, 120 kV, 400 mAs/rot, collimation 64 x 0.6 mm). Datasets were evaluated concerning the presence of significant coronary stenoses and validated against invasive coronary angiography.

Results: In 44 patients with a heart rate 65 beats/min, 566 of 616 coronary segments were evaluable (92%), whereas in 56 patients with a heart rate <65 beats/min, 777 of 778 coronary segments were evaluable (100%, p < 0.001). On a per-patient basis, 93% of patients (65 beats/min) and 100% of patients (<65 beats/min) were considered evaluable. By classifying unevaluable segments as positive for stenosis, per-patient sensitivity was 95% (19 of 20) for heart rates 65 beats/min and 100% (22 of 22) for heart rates <65 beats/min. Specificity was 87% (21 of 24) versus 76% (26 of 34), and overall diagnostic accuracy was 91% (40 of 44) versus 86% (48 of 56). None of these differences were statistically significant. Similarly, no difference in diagnostic accuracy was found in per-vessel and -segment analyses.

Conclusions: In 100 patients studied without beta-blocker pre-medication, DSCT demonstrated slightly lower per-segment evaluability for high heart rates but no decrease in diagnostic accuracy for the detection of coronary artery stenoses.

Abbreviations and Acronyms   CT = computed tomography   DSCT = dual-source computed tomography   ECG = electrocardiogram   MDCT = multidetector computed tomography

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