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Effect of decrease in heart rate variability on the diagnostic accuracy of 64-MDCT coronary angiography


Leschka, S; Scheffel, H; Husmann, L; Gämperli, O; Marincek, B; Kaufmann, P A; Alkadhi, H (2008). Effect of decrease in heart rate variability on the diagnostic accuracy of 64-MDCT coronary angiography. American Journal of Roentgenology, 190(6):1583-1590.

Abstract

OBJECTIVE: The purpose of this study was to evaluate the effect of average heart rate and heart rate variability on the diagnostic accuracy of 64-MDCT in the assessment of coronary artery stenosis. SUBJECTS AND METHODS: CT and invasive coronary angiography were performed on 114 patients (mean age, 62 years) referred for known coronary artery disease (n = 26), atypical chest pain (n = 58), and presurgical exclusion of coronary artery disease before abdominal aortic (n = 14) or cardiac valve (n = 16) surgery. The population was divided into two groups depending on median average heart rate (60.0 beats/min) and median heart rate variability (2.7 beats/min) during scanning. Heart rate variability was calculated as SD from the mean heart rate. Two blinded observers using a 4-point scale independently assessed the quality of images of each coronary artery segment and classified each segment as being stenosed (luminal diameter narrowing > 50%) or not. Invasive coronary angiography was used as the reference standard. RESULTS: In 71 (62.3%) of the patients, 241 significant coronary artery stenoses were identified with invasive coronary angiography. In 11 (9.7%) of the patients, 1.6% (26/1,672) of the segments were not evaluable with CT. Overall sensitivity, specificity, and positive and negative predictive values in a patient-based analysis were 97%, 81%, 90%, and 95%, respectively. Image quality was better (p < 0.05) in the low average heart rate group than in the high average heart rate group, but diagnostic accuracy was comparable for the two groups. In contrast, image quality and diagnostic accuracy were significantly better (p < 0.01) among patients in the low heart rate variability group than in the high heart rate variability group. CONCLUSION: Lower heart rate variability is associated with higher diagnostic accuracy of 64-MDCT coronary angiography.

OBJECTIVE: The purpose of this study was to evaluate the effect of average heart rate and heart rate variability on the diagnostic accuracy of 64-MDCT in the assessment of coronary artery stenosis. SUBJECTS AND METHODS: CT and invasive coronary angiography were performed on 114 patients (mean age, 62 years) referred for known coronary artery disease (n = 26), atypical chest pain (n = 58), and presurgical exclusion of coronary artery disease before abdominal aortic (n = 14) or cardiac valve (n = 16) surgery. The population was divided into two groups depending on median average heart rate (60.0 beats/min) and median heart rate variability (2.7 beats/min) during scanning. Heart rate variability was calculated as SD from the mean heart rate. Two blinded observers using a 4-point scale independently assessed the quality of images of each coronary artery segment and classified each segment as being stenosed (luminal diameter narrowing > 50%) or not. Invasive coronary angiography was used as the reference standard. RESULTS: In 71 (62.3%) of the patients, 241 significant coronary artery stenoses were identified with invasive coronary angiography. In 11 (9.7%) of the patients, 1.6% (26/1,672) of the segments were not evaluable with CT. Overall sensitivity, specificity, and positive and negative predictive values in a patient-based analysis were 97%, 81%, 90%, and 95%, respectively. Image quality was better (p < 0.05) in the low average heart rate group than in the high average heart rate group, but diagnostic accuracy was comparable for the two groups. In contrast, image quality and diagnostic accuracy were significantly better (p < 0.01) among patients in the low heart rate variability group than in the high heart rate variability group. CONCLUSION: Lower heart rate variability is associated with higher diagnostic accuracy of 64-MDCT coronary angiography.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Language:English
Date:2008
Deposited On:29 Sep 2008 10:04
Last Modified:05 Apr 2016 12:27
Publisher:American Roentgen Ray Society
ISSN:0361-803X
Publisher DOI:10.2214/AJR.07.2000
PubMed ID:18492910
Permanent URL: http://doi.org/10.5167/uzh-3594

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