Dual-source computed tomography coronary angiography in patients with high heart rate

Abstract

Although single-source 64-multislice computed tomography coronary angiography (SSCTA) needs to reduce heart rate (HR), dual-source computed tomography coronary angiography (DSCTA) can acquire images even in tachycardia. The accuracy of DSCTA during tachycardia is compared to the accuracy of SSCTA at reduced HR. Patients who received invasive coronary angiography and either SSCTA or DSCTA were included. In the SSCTA group, HR was reduced to <65 beats per minute (bpm) with β-blocker (n = 27), while in the DSCTA group patients whose HR was >65 bpm were selected (n = 27). The diagnostic accuracy for significant coronary stenosis was calculated by comparing the invasive coronary angiography. Using dual-Doppler echocardiography, isovolumic relaxation time (IRT) and diastasis time (DT) were evaluated in these patients. In SSCTA, sensitivity was 89 %, specificity 99 %, the positive predictive value (PPV) 94 %, and the negative predictive value (NPV) was 98 %. In DSCTA, sensitivity was 96 %, the specificity was 99 %, PPV was 91 %, and NPV was 99 % (all NS compared to SSCTA). When HR was >75 bpm, DT was markedly shortened (<83 ms), however IRT was maintained >85 ms. Thus, the image reconstruction at the phase of IRT is feasible in DSCTA because of its temporal resolution of 83 ms. High temporal resolution of DSCTA shows equivalent accuracy of coronary stenosis detection to SSCTA, without reducing heart rate, because of its image reconstruction at IRT.

Resolution of Inferior Wall Ischemia after Successful Revascularization of LAD Lesion: The Value of Myocardial Perfusion Imaging in Guiding Management of Multi-vessel CAD

“…Sixty-four slices cardiac computed tomography (CT) was performed as the initial non-invasive imaging work-up for possible coronary artery disease (CAD). The coronary calcium scoring was 70, 60 and 0 for left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA), respectively [1]. CT coronary angiography (CTA) revealed: (A) noncalcified plaques at proximal RCA with nearly total occlusion (arrows); and (B) mixed calcified and non-calcified plaques at proximal LAD also with nearly total occlusion (arrows).…”