Panajotu Alexisz, Vecsey-Nagy Milán, Jermendy Ádám Levente, Boussoussou Melinda, Vattay Borbála, Kolossváry Márton, Zs Dombrády Örs, Csobay-Novák Csaba, Merkely Béla, Szilveszter Bálint
Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary.
Gottsegen National Cardiovascular Center, 29. Haller Street, 1096 Budapest, Hungary.
Diagnostics (Basel). 2023 Jan 22;13(3):406. doi: 10.3390/diagnostics13030406.
There has been an ongoing debate on the means to minimize the time patients spend at health care providers during the COVID-19 pandemic. We propose a strategy relying solely on intravenous (i.v.) beta-blocker administration for heart-rate (HR) control prior to coronary CT angiography (CCTA). We aimed to assess a potential difference in CCTA image quality (IQ) after implementation of a modified strategy compared to our standard protocol of oral premedication during the first wave of COVID-19. We analyzed CCTA examinations conducted one year before ( = 1511) and after ( = 1064) implementation of this new regime. Examinations were performed both on our 256-slice multidetector CT (MDCT) and dedicated cardiac CT (DCCT) scanners. We used a four-point Likert scale (excellent/good/moderate/non-diagnostic) for IQ assessment of the coronaries. We detected a significant increase in mean HR during examinations on both CT scanners (MDCT: 62.4 ± 10.0 vs. 65.3 ± 9.7, < 0.001; DCCT: 61.7 ± 15.2 vs. 65.0 ± 10.7, < 0.001). The rate of moderate/non-diagnostic IQ significantly increased on the MDCT (192/1005, 19.1% vs. 144/466, 30.9%, < 0.001), while this ratio did not change significantly on the DCCT (62/506, 12.3% vs. 84/598, 14.0%, = 0.38). The improved temporal resolution of DCCT allows the stand-alone use of i.v. premedication with preserved IQ; hence, the duration of visits can be shortened.
在新冠疫情期间，关于如何尽量减少患者在医疗服务机构停留时间的讨论一直在进行。我们提出一种策略，即在冠状动脉CT血管造影（CCTA）之前，仅依靠静脉注射β受体阻滞剂来控制心率（HR）。我们旨在评估在新冠疫情第一波期间，与我们口服预处理的标准方案相比，实施改良策略后CCTA图像质量（IQ）的潜在差异。我们分析了在实施这一新方案之前（n = 1511）和之后（n = 1064）进行的CCTA检查。检查在我们的256层多探测器CT（MDCT）和专用心脏CT（DCCT）扫描仪上进行。我们使用四点李克特量表（优秀/良好/中等/非诊断性）对冠状动脉的IQ进行评估。我们发现在两台CT扫描仪上检查期间平均HR均显著增加（MDCT：62.4±10.0对65.3±9.7，P < 0.001；DCCT：61.7±15.2对65.0±10.7，P < 0.001）。MDCT上中等/非诊断性IQ的比例显著增加（192/1005，19.1%对144/466，30.9%，P < 0.001），而DCCT上该比例没有显著变化（62/506，12.3%对84/598，14.0%，P = 0.38）。DCCT改进的时间分辨率允许单独使用静脉预处理且保持IQ；因此，可以缩短就诊时间。
