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Prospective and retrospective ECG-gating for CT coronary angiography perform similarly accurate at low heart rates


Stolzmann, P; Goetti, R; Baumueller, S; Plass, A; Falk, V; Scheffel, H; Feuchtner, G; Marincek, B; Alkadhi, H; Leschka, S (2011). Prospective and retrospective ECG-gating for CT coronary angiography perform similarly accurate at low heart rates. European Journal of Radiology, 79(1):85-91.

Abstract

OBJECTIVE: To compare, in patients with suspicion of coronary artery disease (CAD) and low heart rates, image quality, diagnostic performance, and radiation dose values of prospectively and retrospectively electrocardiography (ECG)-gated dual-source computed tomography coronary angiography (CTCA) for the diagnosis of significant coronary stenoses. MATERIALS AND METHODS: Two-hundred consecutive patients with heart rates </=70bpm were retrospectively enrolled; 100 patients undergoing prospectively ECG-gated CTCA (group 1) and 100 patients undergoing retrospectively-gated CTCA (group 2). Coronary artery segments were assessed for image quality and significant luminal diameter narrowing. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy of both CTCA groups were determined using conventional catheter angiography (CCA) as reference standard. Radiation dose values were calculated. RESULTS: Both groups were comparable regarding gender, body weight, cardiovascular risk profile, severity of CAD, mean heart rate, heart rate variability, and Agatston score (all p>0.05). There was no significant difference in the rate of non-assessable coronary segments between group 1 (1.6%, 24/1404) and group 2 (1.4%, 19/1385; p=0.77); non-diagnostic image quality was significantly (p<0.001) more often attributed to stair step artifacts in group 1. Segment-based sensitivity, specificity, PPV, NPV, and accuracy were 98%, 98%, 88%, 100%, and 100% among group 1; 96%, 99%, 90%, 100%, and 98% among group 2, respectively. Parameters of diagnostic performance were similar (all p>0.05). Mean effective radiation dose of prospectively ECG-gated CTCA (2.2+/-0.4mSv) was significantly (p<0.0001) smaller than that of retrospectively ECG-gated CTCA (8.1+/-0.6mSv). CONCLUSION: Prospectively ECG-gated CTCA yields similar image quality, performs as accurately as retrospectively ECG-gated CTCA in patients having heart rates </=70bpm while being associated with a lower mean effective radiation dose.

Abstract

OBJECTIVE: To compare, in patients with suspicion of coronary artery disease (CAD) and low heart rates, image quality, diagnostic performance, and radiation dose values of prospectively and retrospectively electrocardiography (ECG)-gated dual-source computed tomography coronary angiography (CTCA) for the diagnosis of significant coronary stenoses. MATERIALS AND METHODS: Two-hundred consecutive patients with heart rates </=70bpm were retrospectively enrolled; 100 patients undergoing prospectively ECG-gated CTCA (group 1) and 100 patients undergoing retrospectively-gated CTCA (group 2). Coronary artery segments were assessed for image quality and significant luminal diameter narrowing. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy of both CTCA groups were determined using conventional catheter angiography (CCA) as reference standard. Radiation dose values were calculated. RESULTS: Both groups were comparable regarding gender, body weight, cardiovascular risk profile, severity of CAD, mean heart rate, heart rate variability, and Agatston score (all p>0.05). There was no significant difference in the rate of non-assessable coronary segments between group 1 (1.6%, 24/1404) and group 2 (1.4%, 19/1385; p=0.77); non-diagnostic image quality was significantly (p<0.001) more often attributed to stair step artifacts in group 1. Segment-based sensitivity, specificity, PPV, NPV, and accuracy were 98%, 98%, 88%, 100%, and 100% among group 1; 96%, 99%, 90%, 100%, and 98% among group 2, respectively. Parameters of diagnostic performance were similar (all p>0.05). Mean effective radiation dose of prospectively ECG-gated CTCA (2.2+/-0.4mSv) was significantly (p<0.0001) smaller than that of retrospectively ECG-gated CTCA (8.1+/-0.6mSv). CONCLUSION: Prospectively ECG-gated CTCA yields similar image quality, performs as accurately as retrospectively ECG-gated CTCA in patients having heart rates </=70bpm while being associated with a lower mean effective radiation dose.

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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 > University Hospital Zurich > Clinic for Cardiovascular Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2011
Deposited On:22 Mar 2010 14:59
Last Modified:07 Dec 2017 00:02
Publisher:Elsevier
ISSN:0720-048X
Publisher DOI:https://doi.org/10.1016/j.ejrad.2009.12.016
PubMed ID:20079993

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