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European Heart Journal Advance Access originally published online on December 23, 2008
European Heart Journal 2009 30(5):600-607; doi:10.1093/eurheartj/ehn536
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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

Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating

Lars Husmann1, Bernhard A. Herzog1, Oliver Gaemperli1, Fuminari Tatsugami1, Nina Burkhard1, Ines Valenta1, Patrick Veit-Haibach1, Christophe A. Wyss1, Ulf Landmesser1 and Philipp A. Kaufmann1,2,*

1 Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, NUK C 42, CH-8091 Zurich, Switzerland
2 Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

Received 24 April 2008; revised 25 September 2008; accepted 6 November 2008; online publish-ahead-of-print 23 December 2008.

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

Aims: To determine diagnostic accuracy, effective radiation dose, and potential value of computed tomography coronary angiography (CTCA) for hybrid imaging with single-photon emission computed tomography (SPECT) comparing prospective electrocardiogram (ECG)-triggering vs. retrospective ECG-gating.

Methods and results: Two hundred patients underwent standard myocardial stress/rest- SPECT perfusion imaging, which served as standard of reference. One hundred consecutive patients underwent 64-slice CTCA using prospective ECG-gating, and were compared with 100 patients who had previously undergone CTCA using retrospective ECG-gating. For predicting ischaemia, CTCA with prospective ECG-triggering and a stenosis cut-off >50% had a per-vessel sensitivity, specificity, negative, and positive predictive value of 100, 84, 100, and 30%; respective values for CTCA with retrospective ECG-gating were similar (P = n.s.): 86, 83, 98, and 33%. Combining CTCA with stress-only SPECT revealed 100% clinical agreement with regard to perfusion defects, and provided additional information in half the patients on preclinical coronary findings. Effective radiation dose was 2.2 ± 0.7 mSv for CTCA with prospective ECG-triggering, and 19.7 ± 4.2 mSv with retrospective ECG-gating (P < 0.001) (5.4 ± 0.8 vs. 24.1 ± 4.3 mSv for hybrid imaging).

Conclusion: Prospective ECG-triggering for CTCA reduces radiation dose by almost 90% without affecting diagnostic performance. Combined imaging with stress-only SPECT is an attractive alternative to standard stress/rest-SPECT for evaluation of coronary artery disease, offering additional information on preclinical atherosclerosis.

Key Words: Low dose CT • Prospective ECG-triggering • Retrospective ECG-gating • Computed tomography coronary angiography • Diagnostic accuracy • Hybrid imaging • Stress-only SPECT


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O. Gaemperli, L. Husmann, T. Schepis, P. Koepfli, I. Valenta, W. Jenni, H. Alkadhi, T. F. Luscher, and P. A. Kaufmann
Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization?
Eur. Heart J., August 14, 2009; (2009) ehp304v1.
[Abstract] [Full Text] [PDF]


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