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Non-invasive coronary angiography with multislice spiral computed tomography: impact of heart rate
  1. K Nieman1,
  2. B J Rensing1,
  3. R-J M van Geuns1,
  4. J Vos1,
  5. P M T Pattynama2,
  6. G P Krestin2,
  7. P W Serruys1,
  8. P J de Feyter1
  1. 1Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
  2. 2Department of Radiology, Erasmus University Medical Centre
  1. Correspondence to:
    Dr Koen Nieman, Thoraxcenter Bd 410, Erasmus University Medical Centre Rotterdam, PO Box 2040, Rotterdam 3000 CA, Netherlands;


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.

  • spiral computed tomography
  • coronary artery disease
  • heart rate
  • EBCT, electron beam computed tomography
  • MSCT; enhanced multislice spiral computed tomography

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