OBJECTIVE: To assess the effect of systolic data acquisition for electrocardiography (ECG)-triggered high-pitch computed tomography (CT) on motion artefacts of coronary arteries in patients with high heart rates (HRs). METHODS: Eighty consecutive patients (15 women, age 67 +/- 14 years) with HR >/=70 bpm underwent CT angiography of the thoracic aorta (CTA) on 128-slice dual-source CT in ECG-triggered high-pitch acquisition mode (pitch = 3.2) set at 60% (group A, n = 40) or 30% (group B, n = 40) of the RR interval. Two blinded readers graded coronary artery image quality on a three-point scale. Radiation doses were calculated. RESULTS: Inter-observer agreement in grading image quality of the 1,154 coronary segments was good (kappa = 0.62). HRs were similar in groups A and B (85 +/- 13 bpm vs 85 +/- 14 bpm, p not significant). Significantly fewer coronary segments with non-diagnostic image quality occurred (i.e. score 3) in group B than in group A [2.8% (16/579) vs 8.3% (48/575), p < 0.001]. Seventeen patients (42.5%) of group A and 12 patients (30.0%) of group B had at least one non-diagnostic segment. Effective radiation doses were 2.3 +/- 0.3 mSv for chest CTA. CONCLUSION: A systolic acquisition window for high-pitch dual-source CTA in patients with high HRs (>/=70 bpm) significantly improves coronary artery image quality at a low radiation dose.