Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography

Nerlekar, Nitesh; Ko, Brian; Nasis, Arthur; Cameron, James D.; Leung, M.; Brown, Adam; Wong, D.; Ngu, P.; Troupis, John; Seneviratne, Sujith

doi:10.21037/cdt.2017.03.05

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…All efforts were made to match scan parameters, particularly for kV between baseline and follow-up CT and all CT were performed using a 320-row multi-detector CT using previous institutional protocol 10 . Briefly, all studies were performed on a 320-detector row system (AquilionOne, Toshiba Medical Systems, Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study

Nerlekar

Thakur

Lin

et al. 2020

Sci Rep

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epicardial adipose tissue (eAt) is associated with cardiovascular risk. the longitudinal change in eAt volume (eAtv) and density (eAtd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (ctcA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (cVRf) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline −76 ± 6 HU vs. −86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. in this select group of patients, eAtv consistently increased and eAtd consistently decreased at long-term follow-up and these changes were independent of cVRf, age and statin use. together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that eAt is an independent parameter rather than a surrogate for cardiovascular risk. open Scientific RepoRtS | (2020) 10:7109 | https://doi.org/10.1038/s41598-020-63135-z www.nature.com/scientificreports www.nature.com/scientificreports/ Scientific RepoRtS | (2020) 10:7109 | https://doi.org/10.1038/s41598-020-63135-zwww.nature.com/scientificreports www.nature.com/scientificreports/ however, this is reflective of the current literature in examining relevant associations of EAT. Finally, there is potential for error in using delta EAT values with potential overlap from test-retest variability. Our previous work has demonstrated limits of agreement up to 10 mL higher or lower between observers with a mean bias however of only 1 mL, however our inter-observer correlation was excellent at 0.98 with assessors blinded to scan timing and patient details. conclusion Epicardial adipose tissue volume and density demonstrate significant longitudinal changes in patients with non-obstructive coronary artery disease with a consistent increase in EAT volume and consistent decrease in EAT density. There are no clinical risk factors that appear to associate with the change in EAT parameters and this effect is also independent of statin therapy. This finding may suggest that EAT is an independent marker, rather than surrogate of cardiovascular risk.

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Section: Methodsmentioning

confidence: 99%

The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study

Nerlekar

Thakur

Lin

et al. 2020

Sci Rep

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“…Four primary studies directly analysed the diagnostic accuracy of patients undergoing CTCA with high HRs. 4 , 14 , 15 , 16 …”

Section: Resultsmentioning

confidence: 99%

“…The inclusion of the study by Nerlekar and Colleagues 15 constitutes a deviation from the review protocol, as the group reported on high heart rate where the lower inclusion limit was 60 bpm (compared with 65 bpm, stated for this review). The decision was made to include this study as the investigation still related to the effect of high heart rates on diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of prospectively gated, 128‐slice or greater CTCA at high heart rates: a systematic review and meta‐analysis

Mander

Dobeli

Steffensen

et al. 2021

J of Medical Radiation Sci

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Introduction: Prospectively gated 64-slice CT coronary angiography (CTCA) may be contraindicated for heart rates (HRs) over 65 beats per minute (bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically provide 128 or more slices and superior temporal resolution compared with older models; consequently, diagnostic accuracy for current technology prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of this systematic review was to investigate the diagnostic accuracy of CTCA using 128-slice or greater CT technology when compared with conventional coronary angiography for patients with HRs >65 bpm. Methods: A systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as well as unpublished databases, sources and reference lists. Titles and abstracts were screened by two independent reviewers. Full-text screening was then performed. Studies that determined diagnostic accuracy of coronary artery stenosis in adult patients with high heart rates utilising prospectively gated 128 detector or greater scanners were included. Studies that were included in the review underwent critical appraisal using the QUADAS-2 tool. Results: Ten studies were included in the systematic review, with nine of these included in a diagnostic test accuracy meta-analysis, including six of which reported data at the patient level. Meta-analysis indicated very high pooled sensitivity 100% (95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI 0.69, 0.88). Conclusions: Prospectively gated CT coronary angiography may be justifiable at heart rates above 65 bpm if performed on a 128-slice or greater CT unit. Caution regarding the implication of a positive result is recommended due to reduced specificity. Further evidence is required before consideration of a new higher heart threshold.

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“…37,38 Recently developed high spatial resolution and wider CTA detector coverage may provide a solution for this issue in the near future. 39 In conclusion, a novel on-site vFFR computing system employing a fully automated segmentation algorithm using a parallel computation method showed excellent diagnostic performance for the detection of lesion-specific ischemia and was significantly faster and cheaper. (%)…”

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confidence: 92%

Diagnostic Accuracy of a Novel On-site Virtual Fractional Flow Reserve Parallel Computing System

et al. 2020

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Purpose: To evaluate the diagnostic accuracy of a novel on-site virtual fractional flow reserve (vFFR) derived from coronary computed tomography angiography (CTA). Materials and Methods: We analyzed 100 vessels from 57 patients who had undergone CTA followed by invasive FFR during coronary angiography. Coronary lumen segmentation and three-dimensional reconstruction were conducted using a completely automated algorithm, and parallel computing based vFFR prediction was performed. Lesion-specific ischemia based on FFR was defined as significant at ≤0.8, as well as ≤0.75, and obstructive CTA stenosis was defined that ≥50%. The diagnostic performance of vFFR was compared to invasive FFR at both ≤0.8 and ≤0.75. Results: The average computation time was 12 minutes per patient. The correlation coefficient (r) between vFFR and invasive FFR was 0.75 [95% confidence interval (CI) 0.65 to 0.83], and Bland-Altman analysis showed a mean bias of 0.005 (95% CI -0.011 to 0.021) with 95% limits of agreement of -0.16 to 0.17 between vFFR and FFR. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 78.0%, 87.1%, 72.5%, 58.7%, and 92.6%, respectively, using the FFR cutoff of 0.80. They were 87.0%, 95.0%, 80.0%, 54.3%, and 98.5%, respectively, with the FFR cutoff of 0.75. The area under the receiver-operating characteristics curve of vFFR versus obstructive CTA stenosis was 0.88 versus 0.61 for the FFR cutoff of 0.80, respectively; it was 0.94 versus 0.62 for the FFR cutoff of 0.75. Conclusion: Our novel, fully automated, on-site vFFR technology showed excellent diagnostic performance for the detection of lesion-specific ischemia.

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Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography

Abstract: In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.

Cited by 10 publications

References 24 publications

The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study

The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study

Diagnostic accuracy of prospectively gated, 128‐slice or greater CTCA at high heart rates: a systematic review and meta‐analysis

Diagnostic Accuracy of a Novel On-site Virtual Fractional Flow Reserve Parallel Computing System

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