Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: Effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy
Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: Effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy
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DOI：
10.1016/j.ejrad.2007.05.013
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发表时间：
2008-04-01
影响因子：
3.3
通讯作者：
Heuschmid, M.
中科院分区：
文献类型：
--
作者：
Brodoefel, H.;Reimann, A.;Heuschmid, M.
目的：本研究的目的是评估的影响，心率，心率变异性和钙化的图像质量和诊断准确性在一个patient collective.Subjects和方法：102例已知或疑似冠状动脉疾病的连续患者进行了64-MSCT和侵入性冠状动脉造影。图像质量（IQ）由独立观察员使用4分量表进行评估，从优秀（1）到非诊断（4）。在改良的AHA 13节段模型中，评价了MSCT检测或排除显著狭窄（> 50%）的准确性。采用多元回归分析评价心率、心率变异性、钙化和体重指数（BMI）对智商和准确性的影响。智商和准确性进行了进一步分析，在亚组的显着预测变量和简单的回归进行计算阈值为足够的iQ.Results：平均心率为68.2 +/- 13.3 bpm，平均心率变异性11.5 +/- 16.0每拍CT检查（bpct）和中位数Agatston得分226.5。平均IQ评分为2 +/- 0.6，而89%的节段获得了诊断质量。总体敏感性、特异性、PPV或NPV为91.2%、99.2%、95.3%或98.3%。多因素回归分析显示，总智商与心率和钙化程度显著相关（P = 0.0038; P < 0.0001）。心率变异性的影响仅限于RCA节段的IQ（P = 0.018），BMI与IQ无关（P = 0.52）。钙化是唯一对非诊断性节段数量有显著影响的预测变量（P < 0.0001）。多元回归分析显示，钙化也是影响诊断准确性的单因素（P = 0.0049）。结论：心率、心率变异性和钙化均与智商呈负相关，但严重的钙负荷仍是影响诊断准确性的单因素。(c)2007爱思唯尔爱尔兰有限公司保留所有权利。
Objective: The aim of this study was to assess the impact of heart rate, heart rate variability and calcification on image quality and diagnostic accuracy in an unselected patient collective.Subjects and methods: One hundred and two consecutive patients with known or suspected coronary artery disease underwent both 64-MSCT and invasive coronary angiography. Image quality (IQ) was assessed by independent observers using a 4-point scale from excellent (1) to non-diagnostic (4). Accuracy of MSCT regarding detection or exclusion of significant stenosis (> 50%) was evaluated on a per segment basis in a modified AHA 13-segment model. Effects of heart rate, heart rate variability, calcification and body mass index (BMI) on IQ and accuracy were evaluated by multivariate regression. IQ and accuracy were further analysed in subgroups of significant predictor variables and simple regression performed to calculate thresholds for adequate IQ.Results: Mean heart rate was 68.2 +/- 13.3 bpm, mean heart rate variability 11.5 +/- 16.0 beats per CT-examination (bpct) and median Agatston score 226.5. Average IQ score was 2 +/- 0.6 whilst diagnostic quality was obtained in 89% of segments. Overall sensitivity, specificity, PPV or NPV was 91.2%, 99.2%, 95.3% or 98.3%. According to multivariate regression, overall IQ was significantly related to heart rate and calcification (P = 0.0038; P < 0.0001). The effect of heart rate variability was Limited to IQ of RCA segments (P = 0.018); BMI was not related to IQ (P = 0.52). Calcification was the only predictor variable with significant effect on the number of non-diagnostic segments (P < 0.0001). In a multivariate regression, calcification was also the single factor with impact on diagnostic accuracy (P = 0.0049).Conclusion: Whilst heart rate, heart rate variability and calcification all show an inverse correlation to IQ, severe calcium burden remains the single factor with translation of such effect into decrease of diagnostic accuracy. (c) 2007 Elsevier Ireland Ltd. All rights reserved.