Randomized Comparison of 64-slice Single- And Dual-Source Computed Tomography Coronary Angiography for the Detection of Coronary Artery Disease

JACC Cardiovasc Imaging. 2008 Mar;1(2):177-86. doi: 10.1016/j.jcmg.2007.11.006.

Abstract

Objectives: The purpose of this study was to analyze the influence of a systematic approach to lower heart rate for coronary computed tomography (CT) angiography on diagnostic accuracy of 64-slice single- and dual-source CT.

Background: Coronary CT angiography is often impaired by motion artifacts, so that routine lowering of heart rate is usually recommended. This is often conceived as a major limitation of the technique. It is expected that higher temporal resolution, such as with dual-source 64-slice CT, would allow diagnostic imaging even without systematic pre-treatment for lowering the heart rate.

Methods: Two hundred patients with suspected coronary artery disease were first randomized to either 64-slice single-source CT (n = 100) or dual-source CT (n = 100) for contrast-enhanced coronary artery evaluation. In each group, patients were further randomized to either receive systematic heart rate control (oral and intravenous beta-blockade for a target heart rate < or =60 beats/min) or receive no premedication. Evaluability of datasets and diagnostic accuracy were compared between groups against the results obtained from invasive angiography.

Results: Systematic pre-treatment lowered heart rate during CT coronary angiography by 10 beats/min. Heart rate control significantly improved evaluability in single-source CT (93% vs. 69% on a per-patient basis, p = 0.005), whereas it did not in dual-source CT (96% vs. 98%). In evaluable patients, sensitivity to detect the presence of at least 1 coronary stenosis by single-source CT was 86% and 79%, respectively, with and without heart rate control (p = NS). For dual-source CT, it was 100% and 95%, respectively (p = NS). The rate of correctly classified patients, defined as evaluable and correct classification as to the presence or absence of at least 1 coronary artery stenosis, was significantly improved by heart rate control in single-source CT (78% vs. 57%, p = 0.04), whereas there was no such influence in dual-source CT (87% vs. 93%).

Conclusions: Systematic heart rate control significantly improves image quality for coronary visualization by 64-slice single-source CT, whereas image quality and diagnostic accuracy remain unaffected in dual-source CT angiography. Improved temporal resolution obviates the need for heart rate control.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adrenergic beta-Antagonists / administration & dosage*
  • Aged
  • Coronary Angiography / instrumentation
  • Coronary Angiography / methods*
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / physiopathology
  • Equipment Design
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Radiographic Image Enhancement
  • Radiographic Image Interpretation, Computer-Assisted
  • Severity of Illness Index
  • Tomography, X-Ray Computed* / instrumentation

Substances

  • Adrenergic beta-Antagonists