@article{CDT13968,
author = {Nitesh Nerlekar and Brian S. Ko and Arthur Nasis and James D. Cameron and Michael Leung and Adam J. Brown and Dennis T. L. Wong and Philip J. Ngu and John M. Troupis and Sujith K. Seneviratne},
title = {Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography},
journal = {Cardiovascular Diagnosis and Therapy},
volume = {7},
number = {3},
year = {2017},
keywords = {},
abstract = {Objective: To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA).
Methods: Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80bpm). A wider phase window was used for the elevated HR group (30–80%). 320-CTCA and ICA were analyzed by independent readers blinded to other data. Significant disease was defined as ≥50% visual stenosis on ICA. Uninterpretable segments by 320-CTCA were considered to be significant on an intention-to-diagnose principle. Image quality was assessed by 5-point Likert score.
Results: Of 107 patients studied (1,662 segments), there was no significant difference in sensitivity, specificity, positive and negative predictive value between patients with HR ≤60 bpm (n=55) vs. HR 61–80 bpm (n=52): 97%, 88%, 95%, 94% vs. 100%, 88%, 95%, 100%; Receiver operator characteristic-area under the curve 0.93 vs. 0.94, P=0.82). Overall per-patient diagnostic accuracy was 96% in both groups with no significant difference in interpretable segments (Likert ≥2) or median radiation dose (2.4 mSv vs. 2.7 mSv, P=0.35). Only 4/1,662 (0.2%) segments were uninterpretable by motion artefact in the whole cohort.
Conclusions: In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.},
issn = {2223-3660}, url = {https://cdt.amegroups.org/article/view/13968}
}