Department of Radiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Radiology. 2009 Dec;253(3):672-80. doi: 10.1148/radiol.2533090358. Epub 2009 Oct 28.
To investigate the effect of heart rate frequency (HRF) and heart rate variability (HRV) on radiation exposure, image quality, and diagnostic performance to help detect significant stenosis (> or =50% lumen diameter reduction) by using adaptive electrocardiographic (ECG) pulsing at dual-source (DS) spiral computed tomographic (CT) coronary angiography.
Institutional review committee approval and informed consent were obtained. No prescan beta-blockers were applied. Unenhanced CT and CT coronary angiography with adaptive ECG pulsing were performed in 927 consecutive patients (600 men, 327 women; mean age, 60.3 years +/- 11.0 [standard deviation]) divided in three HRF groups: low, intermediate, and high (< or =65, 66-79, and > or =80 beats/min, respectively), and four HRV groups given mean interbeat difference (IBD) during CT coronary angiography: normal, minor, moderate, and severe (IBDs of 0-1, 2-3, 4-10, and >10, respectively). Radiation exposure and image quality were also evaluated. In 444 of these, diagnostic performance was presented as sensitivity, specificity, positive predictive values (PPVs), and negative predictive values and likelihood ratios with corresponding 95% confidence intervals by using quantitative coronary angiography as the reference standard.
CT coronary angiography yielded good image quality in 98% of patients and no significant differences in image quality were found among HRF and HRV groups. Radiation exposure was significantly higher in patients with low versus high HRF and in patients with severe versus normal HRV. No significant differences among HRF and HRV groups in image quality and diagnostic performance were found. A nonsignificant trend was found toward a lower specificity and PPV in patients with a high HRF or severe HRV when compared with low HRF or normal HRV in patients with a low calcium score (Agatston score <100).
DS spiral CT coronary angiography performed with adaptive ECG pulsing results in preserved diagnostic image quality and performance independent of HRF or HRV at the cost of limited dose reduction in arrhythmic patients.
通过使用双源（DS）螺旋 CT 冠状动脉造影的自适应心电图（ECG）脉冲，研究心率频率（HRF）和心率变异性（HRV）对辐射暴露、图像质量和诊断性能的影响，以帮助检测显著狭窄（> = 50%管腔直径减少）。
获得机构审查委员会批准和知情同意。无预扫描β受体阻滞剂。对 927 例连续患者（600 例男性，327 例女性；平均年龄 60.3 岁 +/- 11.0[标准差]）进行非增强 CT 和 CT 冠状动脉造影，并分为三组 HRF 组：低、中、高（分别为 HRF< or =65、66-79 和> or =80 次/分）和四组 HRV 组，在 CT 冠状动脉造影期间分别给予平均心动周期差异（IBD）：正常、轻度、中度和重度（IBD 分别为 0-1、2-3、4-10 和> 10）。还评估了辐射暴露和图像质量。在其中的 444 例中，使用定量冠状动脉造影作为参考标准，呈现出诊断性能，表现为敏感性、特异性、阳性预测值（PPV）和阴性预测值和似然比及其 95%置信区间。
CT 冠状动脉造影在 98%的患者中获得良好的图像质量，并且在 HRF 和 HRV 组之间没有发现图像质量的显著差异。与高 HRF 相比，低 HRF 患者的辐射暴露明显更高，与正常 HRV 相比，严重 HRV 患者的辐射暴露也明显更高。在 HRF 和 HRV 组之间，图像质量和诊断性能没有发现显著差异。在低钙分数（Agatston 评分<100）的患者中，与低 HRF 或正常 HRV 的患者相比，高 HRF 或严重 HRV 的患者的特异性和 PPV 略有下降，但无统计学意义。
使用自适应 ECG 脉冲进行的 DS 螺旋 CT 冠状动脉造影可在保持诊断图像质量和性能的同时，降低心律失常患者的剂量，而与 HRF 或 HRV 无关。
