CARDIOVASCULAR MEDICINE

Non-invasive coronary angiography with multislice spiral computed tomography: impact of heart rate

K Nieman¹, B J Rensing¹, R-J M van Geuns¹, J Vos¹, P M T Pattynama², G P Krestin², P W Serruys¹, P J de Feyter¹

¹ Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
² Department of Radiology, Erasmus University Medical Centre

Correspondence to:
Correspondence to:
Dr Koen Nieman, Thoraxcenter Bd 410, Erasmus University Medical Centre Rotterdam, PO Box 2040, Rotterdam 3000 CA, Netherlands;
koennieman{at}hotmail.com

Objective: To evaluate the impact of heart rate on the diagnostic accuracy of coronary angiography by multislice spiral computed tomography (MSCT).

Design: Prospective observational study.

Patients: 78 patients who underwent both conventional and MSCT coronary angiography for suspicion of de novo coronary artery disease (n=53) or recurrent coronary artery disease after percutaneous intervention (n=25).

Setting: Tertiary referral centre.

Methods: Intravenously contrast enhanced MSCT coronary angiography was done during a single breath hold, and ECG synchronised images were reconstructed retrospectively. All coronary segments of 2.0 mm without stents were evaluated by two investigators and compared with quantitative coronary angiography. Patients were classified according to the average heart rate (mean (SD)) into three equally sized groups: group 1, 55.8 (4.1) beats/min; group 2, 66.6 (2.8) beats/min; group 3, 81.7 (8.8) beats/min.

Results: Image quality was sufficient for analysis in 78% of the coronary segments in patients in group 1, 73% in group 2, and 54% in group 3 (p < 0.01). The sensitivity and specificity for detecting significant stenoses ( 50% lumen reduction) in these assessable segments were: 97% (95% confidence interval (CI) 84% to 100%) and 96% in group 1; 74% (52% to 89%) and 94% in group 2; and 67% (33% to 90%) and 94% in group 3 (p < 0.05). Accounting for all segments of 2.0 mm, including lesions in non-assessable segments as false negatives, the sensitivity decreased to 82% (28/34 lesions, 95% CI 69% to 91%), 61% (14/23 lesions, 42% to 77%), and 32% (6/19 lesions, 15% to 50%), respectively (p < 0.01).

Conclusions: MSCT allows reliable coronary angiography in patients with low heart rates.

Keywords: spiral computed tomography; coronary artery disease; heart rate

Abbreviations: EBCT, electron beam computed tomography; MSCT; enhanced multislice spiral computed tomography

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