Abstract
ObjectivesTo 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).MethodsEighty-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).ResultsOnly 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.ConclusionsProspectively 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.
Highlights
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and increases in incidence and prevalence with age [1, 2]
No significant impact on image quality was found for mean heart rate (HR) (94.9±21.8 bpm; r=0.034, p=0.758; F=0.413, p=0.663) or heart rate variation (HRV) (67.5±22.8 bpm; r=0.097, p=0.377; F=0.111, p=0.895)
AF has previously been regarded as a contraindication for Coronary CT angiography (CCTA), due to increased heart rate variation (HRV) which can lead to severe motion artifacts [12,13,14]
Summary
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and increases in incidence and prevalence with age [1, 2]. Coronary CT angiography (CCTA) as a noninvasive imaging examination has shown reliable diagnostic accuracy with regard to the detection and quantification of coronary artery lesions [3, 4]. In recent years, it has been widely investigated regarding its potential to exclude CAD in patients with a low or intermediate pre-test probability [5, 6]. AF has previously been regarded as a contraindication for CCTA, due to increased heart rate variation (HRV) which can lead to severe motion artifacts [12,13,14]. Second-generation dual-source CT with two x-ray tubes and faster rotation times (280 ms) offers higher temporal resolution (75 ms), which is expected to decrease motion artifacts in patients with high HR as well as patients with AF
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