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European Heart Journal Advance Access originally published online on November 7, 2008
European Heart Journal 2008 29(24):3037-3042; doi:10.1093/eurheartj/ehn485
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience

Bernhard A. Herzog1, Lars Husmann1, Nina Burkhard1, Oliver Gaemperli1, Ines Valenta1, Fuminari Tatsugami1, Christophe A. Wyss1, Ulf Landmesser1 and Philipp A. Kaufmann1,2,*

1 Cardiovascular Center, Raemistrasse 100, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
2 Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland

Received 6 February 2008; revised 19 September 2008; accepted 9 October 2008; online publish-ahead-of-print 7 November 2008.

* Corresponding author. Tel: +41 44 255 4196, Fax: +41 44 255 4414, Email: pak{at}usz.ch

See page 2955 for the editorial comment on this article (doi:10.1093/eurheartj/ehn518)

Aims: To evaluate the accuracy of low-dose computed tomography coronary angiography (CTCA) using prospective ECG-triggering for the assessment of coronary artery disease (CAD).

Methods and results: A total of 30 patients (19 males, 11 females, mean age 58.8 ± 9.9 years) underwent low-dose CTCA and invasive coronary angiography (CA) [median 2 days (0, 41)]. Before CT scanning, intravenous beta-blocker was administered in 18 of 30 patients as heart rate (HR) was >65 b.p.m., achieving a mean HR of 55.7 ± 7.9 b.p.m. CAD was defined as coronary artery narrowing ≥50%, using CA as standard of reference. The estimated mean effective radiation dose was 2.1 ± 0.7 mSv (range: 1.0–3.3), yielding 96.0% (383/399) of evaluable segments. On an intention-to-diagnose-base, all non-evaluative segments were included in the analysis. Vessels with a non-evaluative segment and no further finding were censored as false positive. Patient-based analysis revealed sensitivity, specificity, positive predictive value, and negative predictive value of 100, 83.3, 90.0, and 100%, respectively. The respective values per vessel were 100, 88.9, 85.7, and 100%, respectively.

Conclusion: Prospective ECG-triggering allows low-dose CTCA and provides high diagnostic accuracy in the assessment of CAD in patients with stable sinus rhythm and a low heart rate.

Key Words: CT coronary angiography • Diagnostic accuracy • Low dose • Prospective ECG-triggering • Image quality


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