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Zhou B, Tang Z, Huang X, Zhu H, Li X, Xiong H, Yu J, Liao R, Zhang D. Subtraction coronary CT angiography in patients with high heart rate. Acta Cardiol 2023; 78:99-108. [PMID: 35384795 DOI: 10.1080/00015385.2022.2061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
All the previous subtraction coronary CT angiography (CCTA) had strict heart rate (HR) inclusion criteria. In this study, a new subtraction method was applied to patients with various HR. The post-contrast scan time was respectively 3.5 s after ascending aorta peak enhancement while HR >80 bpm, 4 s while 65≤ HR ≤80 bpm and 4.5 s while HR <65 bpm. Forty-six patients who underwent the new subtraction protocol were enrolled and patients were stratified into the high HR group (≥70 bpm) and low HR group (<70 bpm). Eighteen patients with 15 severe calcification segments and 25 stent segments further received invasive coronary angiography (ICA). In all included patients, the coronary artery enhancement was compared between the high and low HR groups. In patients with ICA performed, the image quality improvement and diagnostic effectiveness for detection of significant coronary segments stenosis (>50%) were compared between the conventional CCTA and subtraction CCTA and between the high HR group and low HR group, respectively. All enrolled patients got sufficient coronary artery enhancement. In patients with ICA performed, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the diagnosis of significant stenosis was 0.93 in subtraction CCTA and 0.73 in conventional CCTA (p < 0.05). Furthermore, there were no significant differences in image quality improvement, specificity, positive predictive value and accuracy between the high HR group and low HR group. The new subtraction CCTA method broadened the clinical availability for patients with high HR.
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Affiliation(s)
- Bi Zhou
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hongzhang Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Ruikun Liao
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
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Panajotu A, Vecsey-Nagy M, Jermendy ÁL, Boussoussou M, Vattay B, Kolossváry M, Zs. Dombrády Ö, Csobay-Novák C, Merkely B, Szilveszter B. Coronary CTA Amidst the COVID-19 Pandemic: A Quicker Examination Protocol with Preserved Image Quality Using a Dedicated Cardiac Scanner. Diagnostics (Basel) 2023; 13:406. [PMID: 36766511 PMCID: PMC9914678 DOI: 10.3390/diagnostics13030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
There has been an ongoing debate on the means to minimize the time patients spend at health care providers during the COVID-19 pandemic. We propose a strategy relying solely on intravenous (i.v.) beta-blocker administration for heart-rate (HR) control prior to coronary CT angiography (CCTA). We aimed to assess a potential difference in CCTA image quality (IQ) after implementation of a modified strategy compared to our standard protocol of oral premedication during the first wave of COVID-19. We analyzed CCTA examinations conducted one year before (n = 1511) and after (n = 1064) implementation of this new regime. Examinations were performed both on our 256-slice multidetector CT (MDCT) and dedicated cardiac CT (DCCT) scanners. We used a four-point Likert scale (excellent/good/moderate/non-diagnostic) for IQ assessment of the coronaries. We detected a significant increase in mean HR during examinations on both CT scanners (MDCT: 62.4 ± 10.0 vs. 65.3 ± 9.7, p < 0.001; DCCT: 61.7 ± 15.2 vs. 65.0 ± 10.7, p < 0.001). The rate of moderate/non-diagnostic IQ significantly increased on the MDCT (192/1005, 19.1% vs. 144/466, 30.9%, p < 0.001), while this ratio did not change significantly on the DCCT (62/506, 12.3% vs. 84/598, 14.0%, p = 0.38). The improved temporal resolution of DCCT allows the stand-alone use of i.v. premedication with preserved IQ; hence, the duration of visits can be shortened.
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Affiliation(s)
- Alexisz Panajotu
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | | | | | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, 29. Haller Street, 1096 Budapest, Hungary
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Bécsi út 96/b, 1034 Budapest, Hungary
| | - Örs Zs. Dombrády
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
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Schoepf UJ, Decker J. Slow and Steady Wins the Race: Lower Heart Rates Improve Diagnostic Quality for Coronary CT Angiography. Radiology 2021; 300:704-705. [PMID: 34128727 DOI: 10.1148/radiol.2021211091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 (U.J.S., J.D.); and Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.D.)
| | - Josua Decker
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 (U.J.S., J.D.); and Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.D.)
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Androshchuk V, Sabharwal N, St Noble V, Kelion A. Speeding up beta-blockade prior to coronary CT angiography: can we predict the dose of intravenous metoprolol required to achieve target heart rate in a given patient? Clin Radiol 2020; 76:236.e21-236.e25. [PMID: 33298312 DOI: 10.1016/j.crad.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/30/2020] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the use and safety of intravenous (IV) metoprolol in a cohort of patients undergoing coronary computed tomographic angiography (CCTA) at a university hospital, and in particular, to establish if the minimum dose required to achieve the target heart rate (HR) in a given patient can be predicted from the baseline HR. MATERIALS AND METHODS Patients undergoing CCTA at a tertiary centre between January 2015 and May 2018, with baseline HR ≥60 bpm requiring IV metoprolol, were identified retrospectively from the database. Patients with a contraindication to beta-blockade or an indication for CCTA other than coronary disease were excluded. HR at baseline and at the time of scanning were recorded, together with the total dose of IV metoprolol administered. RESULTS Of 625 patients identified, 330 (52.8%) achieved HR ≤60 with IV metoprolol. Patients who achieved target HR had lower baseline HR. They received a lower radiation exposure due to tight prospective gating and a lower tube voltage. The lower quartile dose of metoprolol administered was 5 mg for patients with baseline HR <65 beats per minute (bpm), but 10 mg for HR 65-74 bpm, and ≥20 mg for higher HRs. There were no cases of symptomatic bradycardia/hypotension. CONCLUSION Patients with a resting HR of ≥60 bpm can reasonably be given an initial minimum dose of 5-20 mg metoprolol IV before CCTA, with additional doses as required.
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Affiliation(s)
- V Androshchuk
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | - N Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - V St Noble
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - A Kelion
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Effectiveness of point-of-care oral ivabradine for cardiac computed tomography. J Cardiovasc Comput Tomogr 2020; 15:226-231. [PMID: 33039320 DOI: 10.1016/j.jcct.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) is increasing seen as a first line investigation in patients with suspected coronary artery disease. Heart-rate control improves the image quality and diagnostic accuracy of CCTA. Typically, beta-blockers are administered to induce sinus bradycardia. Sinus bradycardia may also be induced by ivabradine. We hypothesized that in a real-world population ivabradine would be an effective alternative to metoprolol at heart rate lowering for CCTA. METHODS This was a retrospective analysis of consecutive patients who were exposed to an ivabradine-based (IB) versus a metoprolol-only (MO) protocol to achieve a target heart rate </ = 65bpm. Hemodynamic responses to both strategies were compared along with differences in cost and the time expired from medication administration to CCTA. RESULTS 5955 consecutive patients were included in the analysis: 3211 were imaged during an era of a metoprolol only strategy (MO) and 2744 CCTA following an ivabradine based (IB) strategy. 2676 patients had heart rates >65 and received heart-rate lowering medication: 1958 patients had MO, and 718 received IB protocol. Target heart rate of </ = 65bpm was achieved in 77% of MO and 89% of IB patients (p < 0.01). The time from initial medication administration to CCTA was longer in the IB versus MO patients (77 versus 48 min, p < 0.01). CONCLUSIONS Introduction of a novel single dose ivabradine-based protocol to control heart rate for CCTA was more successful in achieving target heart rate than a metoprolol-only strategy. The use of ivabradine however incurred a 1.6-fold increase in the time delay from medication administration and imaging compared to a metoprolol only protocol.
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Rovere G, Meduri A, Savino G, Flammia FC, Lo Piccolo F, Carafa MRP, Larici AR, Natale L, Merlino B, Marano R. Practical instructions for using drugs in CT and MR cardiac imaging. Radiol Med 2020; 126:356-364. [PMID: 32833196 DOI: 10.1007/s11547-020-01261-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.
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Affiliation(s)
- Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Agostino Meduri
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesco Ciriaco Flammia
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Lo Piccolo
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Rachele Pia Carafa
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
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Lu NH, Liu YS, Liu KI, Hsu SY, Huang YH, Sun CK, Chen TB. Questionable necessity of nitroglycerin for diagnostic coronary artery examination using 320-row multi-detector computed tomography. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:989-999. [PMID: 32741800 DOI: 10.3233/xst-200652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aims to analyze and compare the diagnostic effectiveness of 320-row multi-detector computed tomography for coronary artery angiography (MDCTA) in subjects with and without sublingual vasodilator (nitroglycerin). MATERIALS AND METHODS From September 2015 to September 2016, 70 individuals without history of major cardiovascular diseases who underwent MDCTA for health examination were retrospectively categorized into sublingual nitroglycerin (NTG) and non-NTG groups. Medical history, CT dose index (CTDI), and multi-slice CT images were compared between two groups. A diameter of coronary artery (DA, mm) was computed and analyzed. RESULTS A total of 41 males and 29 females (mean age: 55.43±8.84 years, range: 34- 76) were reviewed. Normal and abnormal MDCTA findings were noted in 54 and 16 participants, respectively, with the detection rate of coronary artery disease being 23%. There was no significant difference in inter-observer variability of coronary CTA image quality and diagnosis between the NTG and non-NTG groups among three experienced radiologists. Although the percentage dilatation of left anterior descending branch (LAD), right coronary artery (RCA) and left circumflex branch (LCX) following in the NTG group were 12.4%, 12.8% and 25.3%, respectively (p < 0.01), there was no significant difference in image quality and diagnosis between the two groups. CONCLUSIONS Despite the recommendation of routine nitroglycerin use for subjects undergoing computed tomography for coronary artery angiography, our results showed no significant advantage of its use in improving image quality and rate of diagnosis accuracy.
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Affiliation(s)
- Nan-Han Lu
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
- Department of Radiology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Shan Liu
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
- Department of Dermatology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Ko-In Liu
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
- Department of Radiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Yen Hsu
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
- Department of Radiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Hui Huang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
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Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute. J Thorac Imaging 2018; 33:225-231. [PMID: 29346192 DOI: 10.1097/rti.0000000000000320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm. MATERIALS AND METHODS One hundred consecutive patients (67±10 y) scheduled for cCTA with 65<HR<80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ test was used to study differences with regard to categorical data. A P-value <0.05 was considered statistically significant. RESULTS cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P<0.001) and motion artifacts (49% vs. 66%; P<0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P<0.01) and overall evaluability (85% vs. 75%; P<0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P<0.01). CONCLUSION MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.
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Kim J, Kang JW, Kim K, Choi SI, Chun EJ, Kim YG, Kim WY, Seo DW, Shin J, Lee H, Jin KN, Ahn S, Hwang SS, Kim KP, Jeong RB, Ha SO, Choi B, Yoon CH, Suh JW, Kim HL, Kim JK, Jang S, Seo JS. SEALONE (Safety and Efficacy of Coronary Computed Tomography Angiography with Low Dose in Patients Visiting Emergency Room) trial: study protocol for a randomized controlled trial. Clin Exp Emerg Med 2018; 4:208-213. [PMID: 29306269 PMCID: PMC5758626 DOI: 10.15441/ceem.17.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.
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Affiliation(s)
- Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeo Goon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Huijai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang-Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Sik Hwang
- Department of Preventive Medicine, Seoul National University School of Public Health, Seoul, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Suwon, Korea
| | - Ru-Bi Jeong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byungho Choi
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hwan Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hack-Lyoung Kim
- Department of Cardiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju Kyoung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Seon Seo
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Reduction of Coronary Motion Artifacts in Prospectively Electrocardiography-Gated Coronary Computed Tomography Angiography Using Monochromatic Imaging at Various Energy Levels in Combination With a Motion Correction Algorithm on Single-Source Fast Tube Voltage Switching Dual-Energy Computed Tomography: A Phantom Experiment. Invest Radiol 2017; 51:513-9. [PMID: 27257865 DOI: 10.1097/rli.0000000000000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to assess the effect of monochromatic imaging at various energy levels in combination with a motion correction algorithm (MCA) in single-source dual-energy coronary computed tomography angiography (CCTA) with fast switching of tube voltage on the reduction of coronary motion artifacts (CMA) in a phantom setting. MATERIALS AND METHODS Using this dual-energy computed tomography technique with a phantom comprising models of coronary vessels filled with contrast medium and pulsating at constant heart rates of 60 to 100 beats per minute, we reconstructed monochromatic images of CCTA obtained at 50 to 90 keV with and without use of MCA. Cardiac motion was modeled by simulating the in vivo time-volume curve of the left ventricle. Two independent readers graded CMA in 9 coronary segments using a 5-point scale (1, poor; 3 to 5, interpretable; 5, excellent). At each heart rate, we compared the average score of CMA between images obtained at 50 to 90 keV with and without use of MCA using Wilcoxon signed rank test, and we compared the score among images obtained at 50 to 90 keV with use of MCA using Kruskal-Wallis and post hoc tests. We also compared the percentages of image interpretability and improvement in image interpretability among images obtained at 50 to 90 keV with use of MCA. RESULTS With the use of MCA, the average score of CMA was significantly higher for images obtained at each energy level from 50 to 70 keV (P < 0.05) and was comparable at 80 and 90 keV, and it was comparable among those obtained at 50 to 70 keV. With its use, the percentages of image interpretability were similarly high at 50 to 70 keV at 60 to 80 beats per minute (78%-100%), and they were higher at 50 to 60 keV (72%-83%) than at 70 keV at 90 to 100 beats per minute (50%-56%). The percentages of improved image interpretability with MCA were similarly high at 50 to 70 keV at 60 to 80 beats per minute (56%-100%), and they were higher at 50 to 60 keV (62%-77%) than at 70 keV at 90 to 100 beats per minute (36%-43%). The percentages of image interpretability and improved image interpretability with MCA were insufficient at 80 and 90 keV. CONCLUSIONS Coronary motion artifacts were significantly reduced in images of monochromatic CCTA obtained at 50 to 70 keV in combination with MCA compared with those obtained without MCA, and the percentages of image interpretability and improved image interpretability with use of MCA were relatively high at 50 to 70 keV, and particularly at 50 to 60 keV, even at 90 to 100 beats per minute.
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Mander GTW. Computed tomography coronary angiography with heart rate control premedication: a best practice implementation project. ACTA ACUST UNITED AC 2017; 15:1968-1976. [PMID: 28708755 DOI: 10.11124/jbisrir-2016-003270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Computed tomography coronary angiography patient preparation with heart rate control premedication is employed in departments across Australia. However, the methods of administration vary widely between institutions and do not always follow best practice. OBJECTIVES This aim of the study was to identify and promote best practice in the administration of heart rate premedication in computed tomography coronary angiography at a regional hospital in Australia. METHODS The Joanna Briggs Institute have validated audit and feedback tools to assist with best practice implementation projects. This project used these tools, which involve three phases of activity - a pre-implementation audit, reflecting on results and implementing strategies to address non-compliance, and a post-implementation audit to assess the outcomes. RESULTS A baseline audit identified non-compliance in the majority of measured audit criteria. Following implementation of an institution-specific guideline and associated worksheet, improved compliance was shown across all audit criteria. CONCLUSIONS Following the development and implementation of institution-specific evidence-based resources relating to heart rate control in computed tomography coronary angiography, a high level of compliance consistent with best practice was achieved.
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Nerlekar N, Ko BS, Nasis A, Cameron JD, Leung M, Brown AJ, Wong DTL, Ngu PJ, Troupis JM, Seneviratne SK. Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography. Cardiovasc Diagn Ther 2017; 7:296-304. [PMID: 28567355 DOI: 10.21037/cdt.2017.03.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA). METHODS Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80 bpm). A wider phase window was used for the elevated HR group (30-80%). 320-CTCA and ICA were analyzed by independent readers blinded to other data. Significant disease was defined as ≥50% visual stenosis on ICA. Uninterpretable segments by 320-CTCA were considered to be significant on an intention-to-diagnose principle. Image quality was assessed by 5-point Likert score. RESULTS Of 107 patients studied (1,662 segments), there was no significant difference in sensitivity, specificity, positive and negative predictive value between patients with HR ≤60 bpm (n=55) vs. HR 61-80 bpm (n=52): 97%, 88%, 95%, 94% vs. 100%, 88%, 95%, 100%; Receiver operator characteristic-area under the curve 0.93 vs. 0.94, P=0.82). Overall per-patient diagnostic accuracy was 96% in both groups with no significant difference in interpretable segments (Likert ≥2) or median radiation dose (2.4 mSv vs. 2.7 mSv, P=0.35). Only 4/1,662 (0.2%) segments were uninterpretable by motion artefact in the whole cohort. CONCLUSIONS In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Michael Leung
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Philip J Ngu
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - John M Troupis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia.,Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
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Ghekiere O, Salgado R, Buls N, Leiner T, Mancini I, Vanhoenacker P, Dendale P, Nchimi A. Image quality in coronary CT angiography: challenges and technical solutions. Br J Radiol 2017; 90:20160567. [PMID: 28055253 PMCID: PMC5605061 DOI: 10.1259/bjr.20160567] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 11/05/2022] Open
Abstract
Multidetector CT angiography (CTA) has become a widely accepted examination for non-invasive evaluation of the heart and coronary arteries. Despite its ongoing success and worldwide clinical implementation, it remains an often-challenging procedure in which image quality, and hence diagnostic value, is determined by both technical and patient-related factors. Thorough knowledge of these factors is important to obtain high-quality examinations. In this review, we discuss several key elements that may adversely affect coronary CTA image quality as well as potential measures that can be taken to mitigate their impact. In addition, several recent vendor-specific advances and future directions to improve image quality are discussed.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
- Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Nico Buls
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
| | | | - Paul Dendale
- Heart Center Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Alain Nchimi
- GIGA Cardiovascular Sciences, Liège University (ULg), Domaine Universitaire du Sart Tilman, Rue de l'hôpital, Liège, Belgium
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Heart-Rate Reduction With Adjusted-Dose Ivabradine in Patients Undergoing Coronary Computed Tomographic Angiography. J Comput Assist Tomogr 2017; 41:360-363. [DOI: 10.1097/rct.0000000000000556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Aguiar Rosa S, Ramos R, Marques H, Santos R, Leal C, Casado H, Saraiva M, Figueiredo L, Cruz Ferreira R. Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Aguiar Rosa S, Ramos R, Marques H, Santos R, Leal C, Casado H, Saraiva M, Figueiredo L, Cruz Ferreira R. Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography. Rev Port Cardiol 2016; 35:673-678. [PMID: 27865676 DOI: 10.1016/j.repc.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/16/2016] [Accepted: 07/08/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT). METHODS Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge. RESULTS During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients. CONCLUSION Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm.
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Affiliation(s)
| | - Ruben Ramos
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Hugo Marques
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Rosana Santos
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Cecília Leal
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Helena Casado
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Márcia Saraiva
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
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Harden S, Bull R, Bury R, Castellano E, Clayton B, Hamilton M, Morgan-Hughes G, O'Regan D, Padley S, Roditi G, Roobottom C, Stirrup J, Nicol E. The safe practice of CT coronary angiography in adult patients in UK imaging departments. Clin Radiol 2016; 71:722-8. [DOI: 10.1016/j.crad.2016.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Ghekiere O, Nchimi A, Djekic J, El Hachemi M, Mancini I, Hansen D, Vanhoenacker P, de Roos A, Dendale P. Coronary Computed Tomography Angiography: Patient-related factors determining image quality using a second-generation 320-slice CT scanner. Int J Cardiol 2016; 221:970-6. [PMID: 27441477 DOI: 10.1016/j.ijcard.2016.07.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the diagnostic confidence of Coronary Computed Tomography Angiography (CCTA) and the effect of patient-related factors on CCTA image quality using a second-generation 320-slice scanner. METHODS AND RESULTS 200 consecutive patients (mean age 60±12years; 109 men) prospectively underwent CCTA. The mean body mass index (BMI) was 27.1±4.9kg/m(2); the median heart rate (HR) was 60.0 (interquartile range (IQR), 53.9-66.1) beats per minute (bpm). The median segment's diameter was 2.8 (IQR, 2.2-3.4) mm. For each coronary segment ≥1.5mm in diameter, two readers scored: diameter narrowing as < or ≥50%, overall diagnostic confidence and motion-related image quality, with interobserver agreement kappa-values of 0.89, 0.91 and 0.61 respectively. Seventy-nine of the 2505 evaluated segments (3.2%) had non-diagnostic image quality because of coronary calcifications (66/79; 83.5%), stent- (6/79; 7.5%), pacemaker- (2/79; 2.5%) or motion-related artifacts (5/79; 6.5%). The effect of patient-related factors on motion-related image quality was investigated by multinomial logistic regression in 181 patients with calcium score (IQR, 0-446.5). Increasing coronary diameter was the most improving image quality factor (odds ratio (OR), 1.8637; p<0.001), marginally followed by lower HR (OR, 0.9547; p<0.001) and calcium score (OR, 0.9997; p=0.04). Gender (p=0.70), age (p=0.24) and BMI (p=0.45) did not affect image quality. CONCLUSION Using a second-generation 320-slice scanner, CCTA diagnostic confidence is predominantly affected by coronary calcifications, whereas motion-related image quality is non-diagnostic only in exceptional cases and mainly influenced by the coronary diameter. For future developments, our study findings therefore suggest greater requirements concerning spatial resolution and calcium-related artifact removal than concerning temporal resolution, especially to improve diagnostic confidence in patient groups with smaller coronary diameters.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, B-4000 Liège, Belgium; Department of Radiology, Jessa Hospital, Stadsomvaart 11, B-3500 Hasselt, Belgium; Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, B-3500 Hasselt, Belgium.
| | - Alain Nchimi
- Liège University (ULg), GIGA Cardiovascular Sciences, Domaine Universitaire du Sart Tilman, Rue de l'hôpital, 1, B-4000 Liège, Belgium
| | - Julien Djekic
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, B-4000 Liège, Belgium
| | - Mounia El Hachemi
- Liège University (ULg), GIGA Cardiovascular Sciences, Domaine Universitaire du Sart Tilman, Rue de l'hôpital, 1, B-4000 Liège, Belgium
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, B-4000 Liège, Belgium
| | - Dominique Hansen
- Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, B-3500 Hasselt, Belgium
| | - Piet Vanhoenacker
- Department of Radiology, OLV Hospital Aalst, Moorselbaan 164, B-9300 Aalst, Belgium
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Albinusdreef, 2, NL-2333 ZA Leiden, The Netherlands
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, B-3500 Hasselt, Belgium; Heart Center Hasselt, Jessa Hospital, Stadsomvaart, 11, B-3500 Hasselt, Belgium
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van Rosendael AR, de Graaf MA, Dimitriu-Leen AC, van Zwet EW, van den Hoogen IJ, Kharbanda RK, Bax JJ, Kroft LJ, Scholte AJ. The influence of clinical and acquisition parameters on the interpretability of adenosine stress myocardial computed tomography perfusion. Eur Heart J Cardiovasc Imaging 2016; 18:203-211. [DOI: 10.1093/ehjci/jew047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/21/2016] [Indexed: 11/12/2022] Open
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kido T, Mochizuki T, Hirano M, Yamada Y, Tanaka R, Kanzaki S, Higashi M, Jinzaki M, Yoshioka K, Kuribayashi S. Radiation-Dose-Lowering Effects of Landiolol Hydrochloride in Coronary Angiography Using Computed Tomography (DELIGHT) – A Prospective Multicenter Study –. Circ J 2016; 80:1225-31. [DOI: 10.1253/circj.cj-15-0962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine
| | | | | | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Ryoichi Tanaka
- Department of Cardiovascular Radiology, Memorial Heart Center, Iwate Medical University
| | - Suzu Kanzaki
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Masahiro Higashi
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Kunihiro Yoshioka
- Department of Cardiovascular Radiology, Memorial Heart Center, Iwate Medical University
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Cademartiri F, Garot J, Tendera M, Zamorano JL. Intravenous ivabradine for control of heart rate during coronary CT angiography: A randomized, double-blind, placebo-controlled trial. J Cardiovasc Comput Tomogr 2015; 9:286-94. [DOI: 10.1016/j.jcct.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Impact of an intra-cycle motion correction algorithm on overall evaluability and diagnostic accuracy of computed tomography coronary angiography. Eur Radiol 2015; 26:147-56. [PMID: 25953001 DOI: 10.1007/s00330-015-3793-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/15/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of a novel intra-cycle motion correction algorithm (MCA) on overall evaluability and diagnostic accuracy of cardiac computed tomography coronary angiography (CCT). METHODS From a cohort of 900 consecutive patients referred for CCT for suspected coronary artery disease (CAD), we enrolled 160 (18 %) patients (mean age 65.3 ± 11.7 years, 101 male) with at least one coronary segment classified as non-evaluable for motion artefacts. The CCT data sets were evaluated using a standard reconstruction algorithm (SRA) and MCA and compared in terms of subjective image quality, evaluability and diagnostic accuracy. RESULTS The mean heart rate during the examination was 68.3 ± 9.4 bpm. The MCA showed a higher Likert score (3.1 ± 0.9 vs. 2.5 ± 1.1, p < 0.001) and evaluability (94%vs.79 %, p < 0.001) than the SRA. In a 45-patient subgroup studied by clinically indicated invasive coronary angiography, specificity, positive predictive value and accuracy were higher in MCA vs. SRA in segment-based and vessel-based models, respectively (87%vs.73 %, 50%vs.34 %, 85%vs.73 %, p < 0.001 and 62%vs.28 %, 66%vs.51 % and 75%vs.57 %, p < 0.001). In a patient-based model, MCA showed higher accuracy vs. SCA (93%vs.76 %, p < 0.05). CONCLUSIONS MCA can significantly improve subjective image quality, overall evaluability and diagnostic accuracy of CCT. KEY POINTS Cardiac computed tomographic coronary angiography (CCT) allows non-invasive evaluation of coronary arteries. Intra-cycle motion correction algorithm (MCA) allows for compensation of coronary motion. An MCA improves image quality, CCT evaluability and diagnostic accuracy.
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Influence of the motion correction algorithm on the quality and interpretability of images of single-source 64-detector coronary CT angiography among patients grouped by heart rate. Jpn J Radiol 2014; 33:84-93. [DOI: 10.1007/s11604-014-0382-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022]
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Entezari P, Collins J, Chalian H, Tore HG, Carr J, Yaghmai V. Impact of beta-blockade premedication on image quality of ECG-gated thoracic aorta CT angiography. Acta Radiol 2014; 55:1180-5. [PMID: 24345768 DOI: 10.1177/0284185113516950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thoracic aortic aneurysm is one of the most common aorta pathologies worldwide, which is commonly evaluated by computed tomography angiography (CTA). One of the routine methods to improve the image quality of CTA is heart rate reduction prior to study by beta-blockade administration. PURPOSE To assess the effect of beta-blockade on image quality of the ascending aorta in electrocardiography (ECG)-gated dual-source CTA (DSCTA) images. MATERIAL AND METHODS In this retrospective study, ECG-gated thoracic aorta CTA images of 40 patients without beta-blocker administration were compared with ECG-gated images of 40 patients with beta-blockade. Images of the aorta were analyzed objectively and subjectively at three levels: sinus of Valsalva (sinus), sinotubular junction (STJ), and mid ascending aorta (MAA). Quantitative sharpness index (SI) and signal-to-noise ratio (SNR) were calculated and two radiologists evaluated the image quality using a 3-point scale. RESULTS Mean heart rate in beta-blocker and non-beta-blocker groups was 61.7 beats per minute (bpm) (range, 58.1-63.9 bpm) and 72.9 bpm (range, 69.3-84.1 bpm), respectively (P < 0.05). Aorta wall SI, SNR, and subjective grading were comparable between the two groups at all three levels (P > 0.05). CONCLUSION Beta-blocker premedication may not be necessary for imaging of ascending aorta with ECG-gated DSCTA.
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Affiliation(s)
- Pegah Entezari
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Jeremy Collins
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Hamid Chalian
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Huseyin Gurkan Tore
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - James Carr
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
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Nakamura Y, Yamaji K, Saho T, Matsuzaki Z, Yuda I, Soga Y, Shirai S, Ando K, Nobuyoshi M. A comparison of bolus injection of landiolol versus oral administration of propranolol before cardiac computed tomography. SPRINGERPLUS 2014; 3:93. [PMID: 24634807 PMCID: PMC3951651 DOI: 10.1186/2193-1801-3-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/28/2014] [Indexed: 11/25/2022]
Abstract
Heart rate (HR) reduction is essential to achieve good image quality for cardiac computed tomography (CCT). We evaluated the efficacy of a bolus injection of landiolol, an ultra-short acting β-blocker, without the administration of oral β-blocker to reduce HR prior to CCT. We enrolled 678 consecutive patients who underwent CCT from December 2011 to March 2012 and divided them into three groups, which were a propranolol group (n = 277), a low-dose landiolol group (n = 188), and a high-dose landiolol group (n = 213). Patients in the propranolol group received oral propranolol (10–20 mg) prior to CCT. Patients in the low-dose and high-dose landiolol groups were administered a bolus injection of landiolol (0.125 mg/kg), while the high-dose group received an additional 3.75 mg of landiolol if the baseline HR was ≥75/min. Although the average HR was significantly lower in the propranolol group (61.6 ± 8.0/min) than in the low-dose landiolol group (64.1 ± 7.4/min, P < 0.001), there was no significant difference in the image quality (P = 0.91). Among patients with baseline HR ≥75/min, the average HR tended to be lower in the high-dose landiolol group (67.2 ± 6.9/min) compared with the low-dose landiolol group (69.0 ± 6.9/min, P = 0.10), and there was a corresponding difference in image quality between these two groups (P = 0.02). In conclusion, Although the decrease of HR was significantly larger in the propranolol group than in the landiolol groups, the image quality was similar. Among the patients who received landiolol, a higher dose was associated with a lower HR and better image quality. Further investigation to assess higher-dose bolus injection of landiolol or bolus injection following oral administration of a β-blocker would be needed.
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Safety of an IV β-Adrenergic Blockade Protocol for Heart Rate Optimization Before Coronary CT Angiography. AJR Am J Roentgenol 2014; 203:759-62. [PMID: 25247941 DOI: 10.2214/ajr.13.11492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sadamatsu K, Koide S, Nakano K, Yoshida K. Heart rate control with single administration of a long-acting β-blocker at bedtime before coronary computed tomography angiography. J Cardiol 2014; 65:293-7. [PMID: 25113950 DOI: 10.1016/j.jjcc.2014.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/24/2014] [Accepted: 07/11/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Beta-blockers are used to control the heart rate prior to coronary computed tomography (CT) angiography. However, in-hospital administration is time-consuming, and it is hard to decrease the heart rate to <60 beats per minute (bpm) when the initial heart rate is increased. In this study, we examined whether the single administration of long-acting β-blocker at bedtime before angiography is effective for achieving the target heart rate. METHODS AND RESULTS A total of 314 consecutive patients with a resting heart rate >60bpm who underwent coronary CT angiography were retrospectively collected. Either bisoprolol or atenolol was orally administered the night before to 166 patients (beta group), and no additional medication was administered to the other 148 patients (control group). When the heart rate was >60bpm on arrival, a β-blocker or verapamil was orally administered at the discretion of the physician. Although the baseline heart rate was not significantly different between the groups, the β-blocker treatment the night before significantly reduced the heart rate compared to control group upon arrival at the hospital and at the time of angiography. The rate of achievement of a heart rate ≤60bpm on arrival at the hospital was significantly higher in the beta group, and even after the additional treatment. CONCLUSIONS Bedtime administration of a long-acting β-blocker the night before coronary CT angiography is an effective option to achieve the target heart rate at the time of examination.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
| | - Sachiko Koide
- Department of Nursing, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Kayoko Nakano
- Department of Nursing, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Keiki Yoshida
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan
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Khan AN, Shuaib W, Nikolic B, Khan MK, Kang J, Khosa F. Absorbed radiation dose in radiosensitive organs using 64- and 320-row multidetector computed tomography: a comparative study. SCIENTIFICA 2014; 2014:305942. [PMID: 25170427 PMCID: PMC4142155 DOI: 10.1155/2014/305942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
Aim. To determine absorbed radiation dose (ARD) in radiosensitive organs during prospective and full phase dose modulation using ECG-gated MDCTA scanner under 64- and 320-row detector modes. Methods. Female phantom was used to measure organ radiation dose. Five DP-3 radiation detectors were used to measure ARD to lungs, breast, and thyroid using the Aquilion ONE scanner in 64- and 320-row modes using both prospective and dose modulation in full phase acquisition. Five measurements were made using three tube voltages: 100, 120, and 135 kVp at 400 mA at heart rate (HR) of 60 and 75 bpm for each protocol. Mean acquisition was recorded in milligrays (mGy). Results. Mean ARD was less for 320-row versus 64-row mode for each imaging protocol. Prospective EKG-gated imaging protocol resulted in a statistically lower ARD using 320-row versus 64-row modes for midbreast (6.728 versus 19.687 mGy, P < 0.001), lung (6.102 versus 21.841 mGy, P < 0.001), and thyroid gland (0.208 versus 0.913 mGy; P < 0.001). Retrospective imaging using 320- versus 64-row modes showed lower ARD for midbreast (10.839 versus 43.169 mGy, P < 0.001), lung (8.848 versus 47.877 mGy, P < 0.001), and thyroid gland (0.057 versus 2.091 mGy; P < 0.001). ARD reduction was observed at lower kVp and heart rate. Conclusions. Dose reduction to radiosensitive organs is achieved using 320-row compared to 64-row modes for both prospective and retrospective gating, whereas 64-row mode is equivalent to the same model 64-row MDCT scanner.
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Affiliation(s)
- Atif N. Khan
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
| | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Mohammad K. Khan
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
| | - Jian Kang
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
| | - Faisal Khosa
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
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Celik O, Atasoy MM, Ertürk M, Yalçın AA, Aksu HU, Diker M, Aktürk İF, Atasoy I. Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy. Acta Radiol 2014; 55:676-81. [PMID: 24052362 DOI: 10.1177/0284185113505276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate. PURPOSE To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy. MATERIAL AND METHODS One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine (n = 63) or i.v. metoprolol (5-10 mg) (n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2). RESULTS Although the HR averages of two groups were not significantly different before medication (HRIv1 = 80 ± 7 bpm vs. HRβ1 = 81 ± 7 bpm; P = 0.42), significant HR reduction was observed in the ivabradine group (HRIv3 = 62 ± 7 bpm) when compared to the metoprolol group (HRβ3 = 66 ± 6 bpm; P = 0.001). Decreases in HR forivabradine (18 ± 6 bpm) was significantly higher than for metoprolol (15 ± 4 bpm; P = 0.003) without relevant side-effects. Ivabradine showed no significant effect on either systolic BP or diastolic BP (siBPIv1, 139 ± 10; siBPIv2, 138 ± 10; P = 0.260; diBPIv1, 81 ± 7; diBPIv2, 81 ± 6; P = 0.59). Nevertheless, metoprolol group demonstrated significant reduction in both SiBP and DiBP (siBPβ1, 136 ± 11; siBPβ2 130 ± 11; P < 0.001; diBPβ1, 81 ± 6; diBPβ2, 78 ± 6; P < 0.001). CONCLUSION Single dose ivabradine is safe and significantly more effective than i.v. metoprolol in decreasing HR in patients under calcium channel-blocker therapy.
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Affiliation(s)
- O Celik
- Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - MM Atasoy
- Maltepe University School of Medicine, Radiology Department, Istanbul, Turkey
| | - M Ertürk
- Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - AA Yalçın
- Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - HU Aksu
- Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - M Diker
- Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Radiology Department, Istanbul, Turkey
| | - İF Aktürk
- Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - I Atasoy
- Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey
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High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety. Clin Radiol 2014; 69:739-44. [DOI: 10.1016/j.crad.2014.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/02/2014] [Accepted: 03/03/2014] [Indexed: 01/21/2023]
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Igarashi A, Fujito K, Hirano M, Fukuda T. Cost minimization analysis of beta-blocker at the time of CT imaging for suspected of coronary heart disease in Japan. J Med Econ 2014; 17:142-7. [PMID: 24351028 DOI: 10.3111/13696998.2013.877021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To conduct a cost-minimization analysis of landiolol for CT diagnosis of coronary heart diseases in patients with tachycardia in Japan. METHODS A decision-tree model was constructed to analyze costs from the healthcare payer's perspective. Drug costs and diagnosis costs, computer tomography coronary angiography (CTCA), and coronary angiography (CAG), are adopted to the model. Landiolol is administered only to slow the heart rate to take CT images appropriately. Since some trials proved that there was no difference between landiolol and placebo in terms of efficacy and safety, this study conducted cost-minimization analysis. Of those suspected of coronary heart diseases, 22.5% are thought to be taking beta-blockers. The success rates for CT scanning for landiolol and placebo, derived from domestic trial data, were 81.4% (96/118, 77.8-84.9%) and 54.2% (64/118, 49.7-58.8%). Patients who failed to take a CT image were thought to take CAG. The healthcare cost was derived from a Japanese fee schedule. Costs of landiolol, CT imaging, and CAG are JPY2634 (USD1 = JPY100, as of November 20, 2013), JPY38,116, and JPY101,322, respectively. The positive rate for CAG, derived from domestic trial data, was 37.1% (33/89, 32.0-42.2%). Various sensitivity analyses, both univariate and probabilistic ones, were conducted. RESULTS In the base case analysis, expected costs per patient for landiolol and placebo were JPY78,956 and JPY82,232, respectively. In budget impact analysis, 81,062 patients are eligible for landiolol and it can save JPY266million for whole patients. Sensitivity analyses suggested the robustness of the results. LIMITATIONS This study did not consider any adverse effects in the decision-tree model. This model was developed especially for measuring the cost-saving effect of landiolol, through decreasing the number of patients who require CAG, due to imaging failure. CONCLUSIONS Landiolol for CTCA diagnosis in patients suspected of coronary heart disease with tachycardia is thought to be cost saving.
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Celik O, Atasoy MM, Erturk M, Yalcin AA, Aksu HU, Diker M, Akturk FI, Erkanli K, Atasoy I, Kiris A. Comparison of different strategies of ivabradine premedication for heart rate reduction before coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2014; 8:77-82. [DOI: 10.1016/j.jcct.2013.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/31/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Lymperopoulos A, Negussie S, Walklett K. β1- and α2C-adrenergic receptor polymorphisms and the antiarrhythmic effect of bucindolol in heart failure with reduced ejection fraction. Pharmacogenomics 2013; 14:1545-9. [PMID: 24088125 DOI: 10.2217/pgs.13.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Anastasios Lymperopoulos
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences, Nova Southeastern University College of Pharmacy, HPD (Terry) Building/Room 1338, Fort Lauderdale, FL 33328-2018, USA
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Lambrechtsen J, Egstrup K. Pre-treatment with a sinus node blockade, ivabradine, before coronary CT angiography: A retrospective audit. Clin Radiol 2013; 68:1054-8. [DOI: 10.1016/j.crad.2013.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/29/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
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Heart rate control with oral ivabradine in computed tomography coronary angiography: A randomized comparison of 7.5mg vs 5mg regimen. Int J Cardiol 2013; 168:362-8. [DOI: 10.1016/j.ijcard.2012.09.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/06/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022]
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Ajlan AM, Heilbron BG, Leipsic J. Coronary Computed Tomography Angiography for Stable Angina: Past, Present, and Future. Can J Cardiol 2013; 29:266-74. [DOI: 10.1016/j.cjca.2012.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 01/02/2023] Open
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38
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Cotarlan V, Brofferio A, Gerhard GS, Chu X, Shirani J. Impact of β(1)- and β(2)-adrenergic receptor gene single nucleotide polymorphisms on heart rate response to metoprolol prior to coronary computed tomographic angiography. Am J Cardiol 2013; 111:661-6. [PMID: 23261005 DOI: 10.1016/j.amjcard.2012.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022]
Abstract
A slow, steady heart rate (HR) is necessary for optimal image quality during coronary computed tomographic angiography. Beta blockers are often used, but the goal HR is not achieved in some patients. The aim of this study was to examine the influence of single-nucleotide polymorphisms (SNPs) of the β(1) (codons 49 and 389) and β(2) (codons 16, 27, and 164) adrenergic receptor (AR) genes on HR response to metoprolol in 200 adults (mean age 56 ± 11 years) referred for coronary computed tomographic angiography (using a 64-slice scanner). Oral and intravenous (IV) metoprolol was given to achieve a goal HR of <60 beats/min. Overall, 37 patients (18.5%) did not reach the goal HR despite the administration of oral (181 ± 116 mg) and IV (4.2 ± 9.4 mg) metoprolol. Patients with the β(1)-AR Ser49Gly or Gly49Gly genotype (n = 49) more often failed to reach an optimal HR compared to those with the Ser49Ser genotype (n = 151) (29% vs 15%, p = 0.04), despite receiving higher doses of oral (210 ± 115 vs 172 ± 115 mg, p = 0.048) and IV (7 ± 13 vs 3 ± 8 mg, p = 0.02) metoprolol. Similarly, patients with the β(1)-AR Gly389Gly genotype (n = 11) more often failed to reach an optimal HR compared to those with the Arg389Arg and Arg389Gly genotypes (n = 189) (45% vs 17%, p = 0.02), despite receiving higher doses of IV (13 ± 15 vs 4 ± 9 mg, p = 0.002) but not oral (162 ± 105 vs 182 ± 117 mg, p = 0.50) metoprolol. Multivariate analysis identified β(1)-AR SNPs at codons 49 and 389 and β(2)-AR SNP at codon 27 as independent predictors of suboptimal HR response. In conclusion, these data indicate that the selected SNPs of β(1)-AR and β(2)-AR genes influence HR response to metoprolol in patients who undergo coronary computed tomographic angiography.
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MESH Headings
- Adrenergic beta-Antagonists/administration & dosage
- Adult
- Aged
- Aged, 80 and over
- Coronary Angiography/methods
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/drug therapy
- Coronary Artery Disease/genetics
- DNA/genetics
- Female
- Genotype
- Heart Rate/genetics
- Humans
- Male
- Metoprolol/administration & dosage
- Middle Aged
- Polymorphism, Single Nucleotide
- Prospective Studies
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-1/metabolism
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Adrenergic, beta-2/metabolism
- Tomography, X-Ray Computed
- Young Adult
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Affiliation(s)
- Vlad Cotarlan
- Department of Cardiology, Geisinger Medical Center, Danville, PA, USA
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39
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Adile KK, Kapoor A, Jain SK, Gupta A, Kumar S, Tewari S, Garg N, Goel PK. Safety and efficacy of oral ivabradine as a heart rate-reducing agent in patients undergoing CT coronary angiography. Br J Radiol 2012; 85:e424-8. [PMID: 22815422 DOI: 10.1259/bjr/22102914] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the role of oral ivabradine as a heart rate reducing agent in patients undergoing CT coronary angiography (CTCA). Despite the routine use of β-blockers prior to CTCA studies, it is not uncommon to have patients with heart rates persistently above the target range of 65 bpm. Ivabradine is a selective inhibitor of the I(f) current, which primarily contributes to sinus node pacemaker activity, and has no significant direct cardiovascular effects such as reduction of blood pressure, cardiac contractility or impairment of cardiac conduction. METHODS We investigated 100 consecutive patients who had been referred for CTCA for the evaluation of suspected coronary artery disease (CAD). Patients were randomised to receive either of the following two pre-medication protocols: oral metorprolol or oral ivabradine. RESULTS Ivabradine was significantly more effective than metorprolol in lowering the heart rate; the mean percentage reduction in heart rate with ivabradine vs metorpolol was 23.89+6.95% vs 15.20+4.50%, respectively (p=0.0001). Metoprolol significantly lowered both systolic and diastolic blood pressure while ivabradine did not. The requirement of additional doses to achieve a target heart rate of <65 beats per min was also significantly more frequent with metoprolol. CONCLUSION Ivabradine is a potentially attractive alternative to currently used drugs for reduction of heart rate in patients undergoing CTCA.
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Affiliation(s)
- K K Adile
- Department of Cardiology, Sanjay Grandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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40
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Bhagalia R, Pack JD, Miller JV, Iatrou M. Nonrigid registration-based coronary artery motion correction for cardiac computed tomography. Med Phys 2012; 39:4245-54. [PMID: 22830758 DOI: 10.1118/1.4725712] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE X-ray computed tomography angiography (CTA) is the modality of choice to noninvasively monitor and diagnose heart disease with coronary artery health and stenosis detection being of particular interest. Reliable, clinically relevant coronary artery imaging mandates high spatiotemporal resolution. However, advances in intrinsic scanner spatial resolution (CT scanners are available which combine nearly 900 detector columns with focal spot oversampling) can be tempered by motion blurring, particularly in patients with unstable heartbeats. As a result, recently numerous methods have been devised to improve coronary CTA imaging. Solutions involving hardware, multisector algorithms, or β-blockers are limited by cost, oversimplifying assumptions about cardiac motion, and populations showing contraindications to drugs, respectively. This work introduces an inexpensive algorithmic solution that retrospectively improves the temporal resolution of coronary CTA without significantly affecting spatial resolution. METHODS Given the goal of ruling out coronary stenosis, the method focuses on "deblurring" the coronary arteries. The approach makes no assumptions about cardiac motion, can be used on exams acquired at high heart rates (even over 75 beats/min), and draws on a fast and accurate three-dimensional (3D) nonrigid bidirectional labeled point matching approach to estimate the trajectories of the coronary arteries during image acquisition. Motion compensation is achieved by employing a 3D warping of a series of partial reconstructions based on the estimated motion fields. Each of these partial reconstructions is created from data acquired over a short time interval. For brevity, the algorithm "Subphasic Warp and Add" (SWA) reconstruction. RESULTS The performance of the new motion estimation-compensation approach was evaluated by a systematic observer study conducted using nine human cardiac CTA exams acquired over a range of average heart rates between 68 and 86 beats/min. Algorithm performance was based-lined against exams reconstructed using standard filtered-backprojection (FBP). The study was performed by three experienced reviewers using the American Heart Association's 15-segment model. All vessel segments were evaluated to quantify their viability to allow a clinical diagnosis before and after motion estimation-compensation using SWA. To the best of the authors' knowledge this is the first such observer study to show that an image processing-based software approach can improve the clinical diagnostic value of CTA for coronary artery evaluation. CONCLUSIONS Results from the observer study show that the SWA method described here can dramatically reduce coronary artery motion and preserve real pathology, without affecting spatial resolution. In particular, the method successfully mitigated motion artifacts in 75% of all initially nondiagnostic coronary artery segments, and in over 45% of the cases this improvement was enough to make a previously nondiagnostic vessel segment clinically diagnostic.
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Failed heart rate control with oral metoprolol prior to coronary CT angiography: effect of additional intravenous metoprolol on heart rate, image quality and radiation dose. Int J Cardiovasc Imaging 2012; 29:199-206. [DOI: 10.1007/s10554-012-0049-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 03/31/2012] [Indexed: 12/13/2022]
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Pichler P, Pichler-Cetin E, Vertesich M, Mendel H, Sochor H, Dock W, Syeda B. Ivabradine versus metoprolol for heart rate reduction before coronary computed tomography angiography. Am J Cardiol 2012; 109:169-73. [PMID: 22011557 DOI: 10.1016/j.amjcard.2011.08.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 12/17/2022]
Abstract
Several studies have demonstrated the correlation of heart rate (HR) and image quality in coronary computed tomography angiography. Beta-blocker administration is critical because of its negative inotropic effect. Ivabradine is a selective HR-lowering agent that exclusively inhibits the I(f) current in sinoatrial node cells without having any effect on cardiac contractility or atrioventricular conduction. A total of 120 patients were randomized to oral premedication with ivabradine 15 mg or metoprolol 50 mg. HR and blood pressure (BP) were measured before the administration of premedication and immediately before coronary computed tomographic angiography. The mean time between premedication administration and follow-up was 108 ± 21.5 minutes for ivabradine and 110 ± 22.2 minutes for metoprolol (p = NS). When comparing groups, there were no significant differences in reduction of HR (-11.83 ± 8.6 vs -13.20 ± 7.8 beats/min, p = NS) and diastolic BP (-5.05 ± 14.2 mm Hg vs -4.08 ± 10.8 mm Hg, p = NS), whereas the decrease of systolic BP was significantly lower in patients who received ivabradine compared to those in the metoprolol group (-3.95 ± 13.6 vs -13.65 ± 17.3 mm Hg, p <0.001). In the subgroup of patients who were receiving long-term β-blocker therapy, significantly stronger HR reduction was achieved with ivabradine (-13.19 ± 5.4 vs -10.04 ± 6.0 beats/min, p <0.05), while the decrease in systolic BP was less (-2.00 ± 13.6 vs -15.04 ± 20.8 mm Hg, p <0.05) compared to metoprolol. In conclusion, ivabradine decreases HR before coronary computed tomographic angiography sufficiently, with significantly less depression of systolic BP compared to metoprolol.
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Affiliation(s)
- Philipp Pichler
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
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Maffei E, Palumbo AA, Martini C, Tedeschi C, Tarantini G, Seitun S, Ruffini L, Aldrovandi A, Weustink AC, Meijboom WB, Mollet NR, Krestin GP, de Feyter PJ, Cademartiri F. "In-house" pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation. Eur Radiol 2011; 19:2931-40. [PMID: 19597820 DOI: 10.1007/s00330-009-1509-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/22/2009] [Indexed: 11/26/2022]
Abstract
We retrospectively evaluated the effect, timing and safety of different pharmacological strategies during 64-slice CT coronary angiography (CT-CA). From the institutional database of CT-CAwe enrolled 560 consecutive patients with suspected coronary artery disease. The type of drug preparation (group 1 = no treatment; group 2 = oral metoprolol; group 3 = other; group 4 = intravenous (IV) atenolol; group 5 = IV atenolol + nitrates; NR = non-responders), timing, and adverse effects were recorded. Heart rate (HR) during different preparation phases was recorded. Four adverse effects were recorded, none of which was attributable to pharmacological treatment. In all groups, except group 1, the HR on arrival was significantly reduced by the pharmacological treatment (p<0.01). Group 4 showed the best (-16±8 bpm) HR reduction. There was no significant effect on HR due to nitrates (p = 0.49), while a slight increase due to contrast material was noted (p<0.05). Average time required for preparation was 44±25min. Groups 4 and 5 showed the most effective timing (8±9 min and 8±8 min, respectively; p<0.01). Pharmacological preparation in patients undergoing CT-CA is safe and effective. Best results in terms of HR reduction and fast preparation are obtained with IV administration of beta-blockers.
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Affiliation(s)
- Erica Maffei
- Department of Radiology and Cardiology, Azienda Ospedaliero - Universitaria di Parma, Italy
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Comparison of a low-osmolar contrast medium, iopamidol, and an iso-osmolar contrast medium, iodixanol, in MDCT coronary angiography. Coron Artery Dis 2011; 21:414-9. [PMID: 20671550 DOI: 10.1097/mca.0b013e328338cd0b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To prospectively compare iopamidol 370, which is a low-osmolar contrast medium and iodixanol 320, which is an iso-osmolar contrast medium, in terms of image quality and nonserious adverse effects that have the potential to influence the image quality in a 16-slice multi-detector row computed tomography coronary angiography. METHODS Sixty patients were divided into two groups to receive iodixanol 320 or iopamidol 370. Image quality was assessed, using a five-point grading scale. Differences in the mean attenuation (Hounsfield units) at the origin of the coronary arteries and on the ascending aorta in both the groups were compared. The number and intensity of adverse effects were compared between the two groups. RESULTS The mean attenuation values of the ascending aorta and the origins of the coronary arteries for the two groups showed no significant difference (P≥0.41). There was no significant difference in terms of image quality between the two groups on all evaluated segments. There was a statistically significant difference in the number of adverse effects (P=0.001) between the two groups. However, in both the iodixanol group and the iopamidol group, there was no significant difference in terms of image quality between the patients with and without adverse effects. CONCLUSION The frequency of adverse effects is lower in the iodixanol group than the iopamidol group. Iodixanol 320 can provide both vascular enhancement and image quality, which is similar to iopamidol 370 in a 16-slice multi-detector row computed tomography coronary angiography. There was no significant difference in terms of overall image quality between the patients with and without adverse effects in either of the groups.
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Absorbed radiation dose in radiosensitive organs during coronary CT angiography using 320-MDCT: effect of maximum tube voltage and heart rate variations. AJR Am J Roentgenol 2011; 195:1347-54. [PMID: 21098194 DOI: 10.2214/ajr.10.4333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to estimate the absorbed radiation dose in radiosensitive organs during coronary MDCT angiography using 320-MDCT and to determine the effects of tube voltage variation and heart rate (HR) control on absorbed radiation dose. MATERIALS AND METHODS Semiconductor field effect transistor detectors were used to measure absorbed radiation doses for the thyroid, midbreast, breast, and midlung in an anthropomorphic phantom at 100, 120, and 135 kVp at two different HRs of 60 and 75 beats per minute (bpm) with a scan field of view of 320 mm, 400 mA, 320 × 0.5 mm detectors, and 160 mm collimator width (160 mm range). The paired Student's t test was used for data evaluation. RESULTS At 60 bpm, absorbed radiation doses for 100, 120, and 135 kVp were 13.41 ± 3.59, 21.7 ± 4.12, and 29.28 ± 5.17 mGy, respectively, for midbreast; 11.76 ± 0.58, 18.86 ± 1.06, and 24.82 ± 1.45 mGy, respectively, for breast; 12.19 ± 2.59, 19.09 ± 3.12, and 26.48 ± 5.0 mGy, respectively, for lung; and 0.37 ± 0.14, 0.69 ± 0.14, and 0.92 ± 0.2 mGy, respectively, for thyroid. Corresponding absorbed radiation doses for 75 bpm were 38.34 ± 2.02, 59.72 ± 3.13, and 77.8 ± 3.67 mGy for midbreast; 26.2 ± 1.74, 44 ± 1.11, and 52.84 ± 4.07 mGy for breast; 38.02 ± 1.58, 58.89 ± 1.68, and 78 ± 2.93 mGy for lung; and 0.79 ± 0.233, 1.04 ± 0.18, and 2.24 ± 0.52 mGy for thyroid. Absorbed radiation dose changes were significant for all organs for both tube voltage reductions as well as for HR control from 75 to 60 bpm at all tube voltage settings (p < 0.05). The absorbed radiation doses for the calcium score protocol were 11.2 ± 1.4 mGy for midbreast, 9.12 ± 0.48 mGy for breast, 10.36 ± 1.3 mGy for lung, and 0.4 ± 0.05 mGy for thyroid. CONCLUSION CT angiography with 320-MDCT scanners results in absorbed radiation doses in radiosensitive organs that compare favorably to those previously reported. Significant dose reductions can be achieved by tube voltage reductions and HR control.
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Mahabadi AA, Achenbach S, Burgstahler C, Dill T, Fischbach R, Knez A, Moshage W, Richartz BM, Ropers D, Schröder S, Silber S, Möhlenkamp S. Safety, efficacy, and indications of beta-adrenergic receptor blockade to reduce heart rate prior to coronary CT angiography. Radiology 2011; 257:614-23. [PMID: 21084413 DOI: 10.1148/radiol.10100140] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For selected indications, coronary computed tomographic (CT) angiography is an established clinical technology for evaluation in patients suspected of having or known to have coronary artery disease. In coronary CT angiography, image quality is highly dependent on heart rate, with heart rate reduction to less than 60 beats per minute being important for both image quality and radiation dose reduction, especially when single-source CT scanners are used. β-Blockers are the first-line option for short-term reduction of heart rate prior to coronary CT angiography. In recent years, multiple β-blocker administration protocols with oral and/or intravenous application have been proposed. This review article provides an overview of the indications, efficacy, and safety of β-blockade protocols prior to coronary CT angiography with respect to different scanner techniques. Moreover, implications for radiation exposure and left ventricular function analysis are discussed.
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Affiliation(s)
- Amir A Mahabadi
- Department of Cardiology, West German Heart Center, University Clinic Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Abstract
Vessel wall imaging of large vessels has the potential to identify culprit atherosclerotic plaques that lead to cardiovascular events. Comprehensive assessment of atherosclerotic plaque size, composition, and biological activity is possible with magnetic resonance imaging (MRI). Magnetic resonance imaging of the atherosclerotic plaque has demonstrated high accuracy and measurement reproducibility for plaque size. The accuracy of in vivo multicontrast MRI for identification of plaque composition has been validated against histological findings. Magnetic resonance imaging markers of plaque biological activity such as neovasculature and inflammation have been demonstrated. In contrast to other plaque imaging modalities, MRI can be used to study multiple vascular beds noninvasively over time. In this review, we compare the status of in vivo plaque imaging by MRI to competing imaging modalities. Recent MR technological improvements allow fast, accurate, and reproducible plaque imaging. An overview of current MRI techniques required for carotid plaque imaging including hardware, specialized pulse sequences, and processing algorithms are presented. In addition, the application of these techniques to coronary, aortic, and peripheral vascular beds is reviewed.
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Rigsby CK, deFreitas RA, Nicholas AC, Leidecker C, Johanek AJ, Anley P, Wang D, Uejima T. Safety and efficacy of a drug regimen to control heart rate during 64-slice ECG-gated coronary CTA in children. Pediatr Radiol 2010; 40:1880-9. [PMID: 20499055 DOI: 10.1007/s00247-010-1711-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/06/2010] [Accepted: 05/05/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND The adult practice for ECG-gated single-source 64-slice coronary CTA (CCTA) includes administering beta-blockers to reduce heart rate. There are limited data on this process in children. OBJECTIVE To evaluate the safety and efficacy of a drug regimen to decrease heart rate before performing CCTA in children. MATERIALS & METHODS IV remifentanil and esmolol infusion were chosen to decrease heart rate in 41 children (mean age 6.5 years) while they were under general anesthesia (GA) for CCTA. Drug doses, changes in heart rate and procedural complications were recorded. CCTA image quality was graded on a scale of 1 to 5. The relationships between image quality and heart rate and image quality and age were evaluated. Patient effective radiation doses were calculated. RESULTS Heart rates were lowered utilizing esmolol (4 children), remifentanil (2 children) or both (35 children); 26 children received nitroglycerin for coronary vasodilation. The mean decrease in heart rate was 26%. There were no major complications. The average image-quality score was 4.4. Higher heart rates were associated with worse image quality (r = 0.67, P < 0.0001). Older age was associated with better image quality (r = 0.66, P < 0.0001). Effective radiation doses were 0.7 to 7.0 mSv. CONCLUSION Heart rate reduction for pediatric CCTA can be safely and effectively achieved while yielding high-quality images.
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Affiliation(s)
- Cynthia K Rigsby
- Department of Medical Imaging, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA.
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Guaricci AI, Schuijf JD, Cademartiri F, Brunetti ND, Montrone D, Maffei E, Tedeschi C, Ieva R, Di Biase L, Midiri M, Macarini L, Di Biase M. Incremental value and safety of oral ivabradine for heart rate reduction in computed tomography coronary angiography. Int J Cardiol 2010; 156:28-33. [PMID: 21095627 DOI: 10.1016/j.ijcard.2010.10.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/13/2010] [Accepted: 10/23/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart rate (HR) reduction is essential to achieve optimal image quality and diagnostic accuracy with computed tomography coronary angiography (CTCA). Administration of ivabradine could be an attractive alternative to beta-blockade to reduce HR. METHODS One-hundred-twenty-three patients referred for CTCA were prospectively enrolled. Patients were divided in two groups depending on the absence or presence of chronic beta-blockade treatment. Within the two groups patients were randomized to either no additional premedication or oral ivabradine for 5 days prior to CTCA. In presence of chronic beta-blockade therapy it was shifted to atenolol 50mg twice a day for 5 days prior to CTCA. HR and blood pressure were assessed at admission (T0), immediately before CTCA (T1) and during CTCA (T2). The target HR was <65 bpm. RESULTS Ivabradine significantly reduced HR during CTCA. Mean relative HR reduction was 15% for controls, 12% for chronic beta-blockade, 19% for ivabradine and 24% for both chronic beta-blockade and ivabradine at T2 (p for trend <0.001). The rate of patients who reached the target HR at T2 was 83% in controls, 71% with chronic beta-blockade, 97% with ivabradine and 97% with both (p for trend <0.05). The percentage of patients that needed additional IV beta-blockade at T1 decreased from 69% to 40% with ivabradine and 30% with both (p for trend <0.05). CONCLUSIONS Ivabradine is safe and effective in increasing the rate of patients at target HR and in reducing the need for additional IV beta-blockade in patients referred for CTCA.
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Torres FS, Crean AM, Nguyen ET, Paul N. Strategies for radiation-dose reduction and image-quality optimization in multidetector computed tomographic coronary angiography. Can Assoc Radiol J 2010; 61:271-9. [PMID: 20605399 DOI: 10.1016/j.carj.2009.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/17/2022] Open
Abstract
The technological evolution of computed tomography (CT) in the last decade has placed CT coronary angiography (CTCA) in the spotlight of imaging modalities available to evaluate patients with coronary artery disease. Widespread utilisation of CTCA has generated concern from the medical community regarding potential health issues related to the significant radiation exposure associated with this method, and several modifications of the CTCA technique have been proposed to reduce the radiation exposure without affecting the diagnostic image quality. This review will discuss a practical approach to performing CTCA to ensure that the radiation dose is minimized while maintaining diagnostic image quality.
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Affiliation(s)
- Felipe S Torres
- Department of Medical Imaging, University of Toronto and University Health Network, Toronto, Ontario, Canada.
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