Impact of PVCs noted during coronary calcium scan on image quality and accuracy in subsequent coronary dual-source CT angiography

Abstract

The purpose of this study was to investigate the impact of the presence of one or more premature ventricular contractions (PVCs) during coronary calcium score scan (CS) on image quality and accuracy of subsequent dual-source coronary CT angiography (DS CCTA). Fifty-three out of 502 patients showed one or more PVCs during CS and built the study group. Sixty consecutively registered patients with sinus rhythm formed the control group. Two independent, blinded readers classified 1,723 coronary artery segments as being of diagnostic or non-diagnostic image quality. All segments with diagnostic image quality were assessed for the presence for significant coronary artery stenosis. Accuracy was calculated using conventional angiography as standard of reference. The percentage of DS CCTA data sets with diagnostic image quality was significantly lower in the study group (79.2%) compared to the control group (90.6%, P < 0.05). The rate of coronary segment with diagnostic image quality was highly significant lower in the study group (89.5%; n = 723/808) compared to the control group (99.4%; n = 908/915; P < 0.001). However, accuracy did not differ in both groups. Significant correlation between non-diagnostic image quality and mean HR was only found in the study group (P = 0.019). The presence of one or more PVCs during CS does not affect accuracy but impairs image quality of subsequent DS CCTA. Mean HR is a predictor of non-diagnostic data sets only in the study group, suggesting more aggressive HR control could be beneficial.

Influence of irregular heart rhythm on radiation exposure, image quality and diagnostic impact of cardiac computed tomography angiography in 4,339 patients. Data from the German Cardiac Computed Tomography Registry

“…In this regard, the presence of one or more premature beats during imaging affected image quality and the rate of non-diagnostic coronary segments, but did not influence the resultant diagnostic accuracy of the technique, compared to the gold standard invasive angiography. 18 Other studies suggested ECG editing in case of heart rhythm irregularities such as atrial fibrillation or premature beats, which can successfully improve image quality and the diagnostic accuracy of coronary CTA. 19,20 So far, limited data are available on the impact of irregular heart rhythm with cardiac CT examinations in real world registries.…”

Lidocaine bolus may facilitate computed tomographic coronary angiography in patients with frequent premature ventricular contractions

“…However, β-blockers are not that effective in temporal suppression of arrhythmias such as frequent PVC [13, 14]. Premature ventricular beats may be a manifestation of obstructive coronary artery disease [15] and occur in up to 10% of patients referred for CTCA [16, 17]. In our experience the percentage of patients with PVC scheduled for CTCA is lower, most likely because of the awareness of the physicians who refer these subjects directly for invasive angiography.…”

“…In our experience the percentage of patients with PVC scheduled for CTCA is lower, most likely because of the awareness of the physicians who refer these subjects directly for invasive angiography. Recently it has been shown that if PVC occur during the calcium score scan, they are also present in the same number during subsequent CTCA and significantly worsen image quality [16]. Therefore, the presence of frequent PVC observed immediately before CTCA is considered as a relative contraindication for the procedure.…”

Salvage of diagnostic quality of image acquired by low-radiation-dose prospectively ECG-triggered coronary CTA during ventricular trigeminy: A case report of a novel image processing method

“…Cardiac motion and misregistration artifacts in a scan performed during premature ventricular contractions can significantly compromise image quality and prevent diagnostic evaluation of the coronary arteries 2, 3. Even the so-called “regularly irregular” rhythms, which are predictable, can trigger arrhythmia rejection algorithms4, 5 during electrocardiogram (ECG)-gated imaging, delaying image acquisition to the next cardiac cycle and hence increasing the total radiation dose 6 .…”