European Heart Journal Advance Access originally published online on December 18, 2007
European Heart Journal
2008 29(2):191-197; doi:10.1093/eurheartj/ehm613
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Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating
1 Department of Medical Radiology and Cardiovascular Center, University Hospital Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland
2 GE Healthcare, Buc, France
3 Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
Received 22 November 2007; revised 10 December 2007; accepted 11 December 2007; online publish-ahead-of-print 18 December 2007.
* Corresponding author: Tel: +41 44 255 3555; Fax: +41 44 255 4414. Email pak{at}usz.ch
See page 153 for the editorial comment on this article (doi:10.1093/eurheartj/ehm614)
Aims: To determine the feasibility of prospective electrocardiogram (ECG)-gating to achieve low-dose computed tomography coronary angiography (CTCA).
Methods and results: Forty-one consecutive patients with suspected (n = 35) or known coronary artery disease (n = 6) underwent 64-slice CTCA using prospective ECG-gating. Individual radiation dose exposure was estimated from the dose-length product. Two independent readers semi-quantitatively assessed the overall image quality on a five-point scale and measured vessel attenuation in each coronary segment. One patient was excluded for atrial fibrillation. Mean effective radiation dose was 2.1 ± 0.6 mSv (range, 1.1–3.0 mSv). Image quality was inversely related to heart rate (HR) (57.3 ± 6.2, range 39–66 b.p.m.; r = 0.58, P < 0.001), vessel attenuation (346 ± 104, range 110–780 HU; r = 0.56, P < 0.001), and body mass index (26.1 ± 4.0, range 19.1–36.3 kg/m2; r = 0.45, P < 0.001), but not to HR variability (1.5 ± 1.0, range 0.2–5.1 b.p.m.; r = 0.28, P = 0.069). Non-diagnostic CTCA image quality was found in 5.0% of coronary segments. However, below a HR of 63 b.p.m. (n = 28), as determined by receiver operator characteristic curve, only 1.1% of coronary segments were non-diagnostic compared with 14.8% with HR of >63 b.p.m. (P < 0.001).
Conclusion: This first experience documents the feasibility of prospective ECG-gating for CTCA with diagnostic image quality at a low radiation dose (1.1–3.0 mSv), favouring HR <63 b.p.m.
Key Words: Low dose • Computed tomography coronary angiography • Feasibility • Prospective ECG-gating
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