Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: Experience in 94 patients

doi:10.1016/S0899-7071(01)00371-0

Clinical Imaging

Volume 26, Issue 2, March–April 2002, Pages 106-111

https://doi.org/10.1016/S0899-7071(01)00371-0 Get rights and content

Abstract

Objectives: Initial reports indicate that coronary artery lesions might be visualized with high sensitivity and specificity by the use of recently introduced multislice computed tomography (MSCT). Current CT technology offers a temporal resolution of 250 ms. In case of heart rates (HRs) >65 beats/min (bpm), however, the reconstruction software switches from a single-phase algorithm (using data from one heart cycle only) to a biphase algorithm using image data of two consecutive heart cycles, improving temporal resolution to down to 125 ms. Thus, it was the aim of the present study to evaluate the influence of the patients' (pts) HR on image quality expressed by vessel segment visibility. Methods and results: MSCT scans (Somatom VZ) were performed in 94 pts. Ten coronary segments were analyzed in each patient with regard to image quality (RCA: segments [sgts] 1–4, LMS: sgt 5, LAD: sgts 5–8, LCX: sgts 11, 12). A total of 697 of 940 (74.1%) sgts were accurately visualizable (RCA: 244/376 [64.9%], LMS: 94/94 [100%], LAD: 232/283 (82.3%), LCX: 146/188 [77.7%]). β-Blocker therapy had a significant influence on mean HR (65 pts on β-blocker, HR 65.1±10.7 bpm vs. 29 pts, HR 71.6±12.2 bpm, P=.01). A significant inverse correlation between HR and segmental visibility was found (r=−.48, P<.0001), with best visibility in pts with lower HRs (n=14 pts with 10 analyzable sgts, HR 60±10.1 vs. n=8 pts with 4 analyzable sgts, HR 79.9±6.9, P<.0001). Conclusions: Our results indicate that vessel visibility is highly dependent on the pts HR. Best vessel visibility was found in pts with HR <65 bpm with single-phase image reconstruction. Thus, it appears to be advisable to evaluate, and if needed, to lower the pts HRs before undergoing MSCT coronary angiography in order to achieve best image quality.

Section snippets

Background

The reliable noninvasive assessment of coronary artery disease would constitute an important step forward in clinical cardiology. Promising results have been reported for electron beam computed tomography (EBCT) with high sensitivity and specificity in the detection of coronary artery stenoses. A limitation of this method was found to be the high incidence of motion artifacts, leading to 25% of unanalyzable vessel segments [1], [2]. The second noninvasive technology for noninvasive coronary

Patients' characteristics and study protocol

Between October 1999 and October 2000, 94 patients who were assigned for conventional selective coronary angiography were included in the present study. The study protocol had been approved by the local ethical committee and all patients gave informed consent. Major inclusion criteria was the indication to undergo invasive cardiologic diagnostics. Clinical exclusion criteria were: age <37 years, renal insufficiency (creatinine >1.5 mg/dl), unstable angina pectoris, acute myocardial infarction,

Results

The clinical characteristics of the study group are summarized in Table 1, and the concurrent medication in Table 2. All patients had a sinus rhythm; mean heart rate of the whole study group was 67.1±11.5 bpm.

Sixty-five of ninety-four (69%) patients (pts) were on β-blocker therapy. These patients had a significantly lower heart rate (HR) than patients without β-blockers (65.1±10.7 bpm vs. 71.6±12.2 bpm, P=.01, see Fig. 4).

Discussion

The most important finding of the present study is that vessel visibility in noninvasive coronary angiography using MSCT is highly dependent on the patient's heart rate.

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Citation Excerpt :
Adequate heart rate (HR) control is paramount for optimal cardiac imaging using single-source 64-slice multidetector computed tomography (64-MSDT).1–5 For these scanners, HR during image acquisition should be below 65 beats per minute (bpm) and preferably lower than 60 bpm for optimal image quality.6 However, commonly used pre-medication regimens with oral or intravenous metoprolol are frequently unsatisfactory.7–9
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Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm.
Avaliar a eficácia e segurança de um protocolo de redução de frequência cardíaca (FC) utilizando esmolol endovenoso após falência de metoprolol oral, em doentes submetidos a angiografia coronária por tomografia computorizada (CCTA) de 64 cortes.
De 2011 a 2014 foram avaliados os indivíduos submetidos a CCTA num único centro. Os indivíduos com FC >60 bpm à admissão receberam 50-200 mg de metoprolol oral pelo menos uma hora antes da CCTA. Esmolol endovenoso em bólus (1-2 mg/kg) foi administrado se FC >65 bpm imediatamente antes da aquisição de imagem. O endpoint primário de eficácia foi FC <65 bpm durante a aquisição de imagem com contraste. O endpoint primário de segurança foi hipotensão ou bradicardia sintomática durante a permanência no hospital.
Foram efetuadas 947 CCTA durante o período de estudo. Em 86% dos casos, metoprolol oral foi o único fármaco utilizado. Foi necessária a administração de esmolol em 130 (14%) doentes. Nos doentes que receberam esmolol, a FC basal reduziu em média de 74±14 bpm para 63±9 bpm (p<0,001). O objetivo primário de FC <65 bpm foi alcançado em 82 desses 130 doentes (63%). Considerando toda a população, o recurso a esmolol permitiu um aumento significativo da proporção de CCTA realizados com FC <65 bpm (86% para 95% [p<0,001]). A administração de esmolol esteve associada a redução estatisticamente, mas não clinicamente, significativa da pressão arterial sistólica (144±22 para 115±17 mmHg; p<0,001). O endpoint combinado de segurança foi observado em dois (1,5%) dos doentes.
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¹: Both authors contributed equally in performing the study, analyzing the data and preparing the manuscript.

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Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: Experience in 94 patients

Abstract

Section snippets

Background

Patients' characteristics and study protocol

Results

Discussion

Am J Cardiol

J Am Coll Cardiol

Eur J Radiol

Lancet

J Am Coll Cardiol

Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary-artery stenoses and occlusions [see comments]

N Engl J Med

MRI assessment of coronary artery disease

Rays

Free-breathing 3D coronary MRA: the impact of “isotropic” image resolution

J Magn Reson Imaging