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Buechel, R R; Husmann, L; Herzog, B A; Pazhenkottil, A P; Nkoulou, R; Ghadri, J R; Treyer, V; von Schulthess, P; Kaufmann, P A (2011). Low-dose computed tomography coronary angiography with prospective electrocardiogram triggering: Feasibility in a large population. Journal of the American College of Cardiology, 57(3):332-336.

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Abstract

OBJECTIVES: We sought to assess the feasibility of prospective electrocardiogram triggering for achieving low-dose computed tomography coronary angiography (CTCA) in a large population.

BACKGROUND: Prospective electrocardiogram triggering dramatically reduces radiation exposure for CTCA but requires heart rate (HR) control to obtain diagnostic image quality. Its feasibility in daily clinical routine has therefore remained to be elucidated.

METHODS: We evaluated 612 patients consecutively referred for CTCA by 64-slice computed tomography. Intravenous metoprolol (2 to 30 mg) was administered if necessary to achieve a target HR below 65 beats/min. Image quality was assessed on a semiquantitative 4-point scale for each coronary segment.

RESULTS: Forty-six (7.5%) patients were deemed ineligible due to irregular heart rhythm (n = 19), insufficient response to metoprolol (n = 21), renal insufficiency (n = 3), or inability to follow breath-hold commands (n = 3). Mean effective radiation dose was 1.8 ± 0.6 mSv with a diagnostic image quality in 96.2% of segments. Finally, low-dose CTCA allowed a firm diagnosis with regard to the presence or absence of coronary artery disease in 527 (86.1%) patients. Intravenous metoprolol to achieve an HR below 65 beats/min was used in 64.4% of patients. Incidence of nondiagnostic segments was inversely related to HR (r = -0.809, p < 0.001). Below an HR cutoff of 62 beats/min, only 1.2% of coronary segments were nondiagnostic.

CONCLUSIONS: Low-dose CTCA by electrocardiogram triggering is feasible in the vast majority of an every-day population. However, HR control is crucial, as an HR below 62 beats/min favors diagnostic image quality.
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Citations

28 citations in Web of Science®
31 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
DDC:570 Life sciences; biology
610 Medicine & health
Language:English
Date:2011
Deposited On:11 Feb 2011 08:14
Last Modified:28 Nov 2013 00:13
Publisher:Elsevier
ISSN:0735-1097
Publisher DOI:10.1016/j.jacc.2010.08.634
PubMed ID:21232672

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