M Abazid Rami, A Smettei Osama, F Eldesoky Akram, Al Saqqah Hanaa, S Alenzi Habiba, A Altorbak Nora, S Altorbak Sarah, Ali Dar Mehboob
Prince Sultan Cardiac Center Qassim (PSCCQ), King Fahad Specialist Hospital.
Qassim College of Medicine, Qassim University, Buraydah, Qassim, Saudi Arabia.
Acta Cardiol Sin. 2018 Jul;34(4):352-358. doi: 10.6515/ACS.201807_34(4).20180222A.
Atrial fibrillation (AF) presents a potential challenge when performing coronary computed tomography angiography (CTA). To date, there is no ideal protocol for CTA in patients with AF. We sought to design a protocol for single-heartbeat coronary CTA in patients with AF.
We enrolled 32 patients with AF and a very low probability of coronary artery disease who were referred for CTA to assess pulmonary vein anatomy for catheter ablation. A 256-slice scanner was used. Twelve patients underwent CTA using non-gated triple Flash (NGTF) consisting of three prospective electrocardiogram (ECG)-triggered helical scans with a built-in ECG simulator, while retrospectively gated helical (RGH) was used in 20 patients. Radiation dose, and a 4-point scale was used to assess coronary artery image quality between CTA scan modes.
A total of 96 vessels were analyzed. The 4-point score showed no significant differences between the RGH and NGTF scans (2.9 ± 0.6 vs. 2.8 ± 0.8, respectively; p = 0.34). The number of coronary arteries with extensive blurring did not significantly differ between the protocols, and included four vessels (6.6%) in RGH vs. three vessels (8.3%) in NGTF (p = 0.5). Radiation exposure was significantly higher with RGH scans, with a dose-length product of 835 ± 146 mGy compared with 382 ± 35 mGy for NGTF (p < 0.0001).
Single heartbeat NGTF CTA has comparable image quality and significantly lower radiation dose compared to RGH scans in patients with AF. Whether this protocol can be used in next-generation computed tomography scanners has yet to be determined.
在进行冠状动脉计算机断层扫描血管造影（CTA）时，心房颤动（AF）带来了潜在挑战。迄今为止，尚无针对AF患者的CTA理想方案。我们试图设计一种用于AF患者单心跳冠状动脉CTA的方案。
我们纳入了32例冠状动脉疾病可能性极低且因AF被转诊进行CTA以评估肺静脉解剖结构以进行导管消融的患者。使用了一台256层扫描仪。12例患者采用非门控三闪（NGTF）进行CTA，包括三次前瞻性心电图（ECG）触发的螺旋扫描及内置ECG模拟器，而20例患者采用回顾性门控螺旋扫描（RGH）。采用辐射剂量，并使用4分制评估CTA扫描模式之间的冠状动脉图像质量。
共分析了96支血管。4分制评分显示RGH和NGTF扫描之间无显著差异（分别为2.9±0.6和2.8±0.8；p=0.34）。方案之间冠状动脉广泛模糊的数量无显著差异，RGH中有4支血管（6.6%），NGTF中有3支血管（8.3%）（p=0.5）。RGH扫描的辐射暴露显著更高，剂量长度乘积为835±146 mGy，而NGTF为382±35 mGy（p<0.0001）。
与AF患者的RGH扫描相比，单心跳NGTF CTA具有相当的图像质量且辐射剂量显著更低。该方案是否可用于下一代计算机断层扫描仪尚未确定。
