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Effect of Decrease in Heart Rate Variability on the Diagnostic Accuracy of 64-MDCT Coronary Angiography

Sebastian Leschka1, Hans Scheffel1, Lars Husmann2, Oliver Gämperli2, Borut Marincek1, Philipp A. Kaufmann2,3 and Hatem Alkadhi1

1 Institute of Diagnostic Radiology, Department of Medical Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
2 Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
3 Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.


Figure 1
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  		Fig. 1A —60-year-old man with atypical chest pain. Average heart rate was 75.6 beats/min, and heart rate variability was 1.6 beats/min. Image quality of 64-MDCT coronary angiography was rated good to excellent in all segments. Curved planar CT image along centerline of left anterior descending artery shows coronary artery stenosis in proximal segment. Reconstructions perpendicular to proximal left anterior descending artery (magnified views 1-3) show noncalcified plaque causing approximately 70% luminal diameter stenosis. Maximum intensity projection (inset 4) shows plaque composed of calcified and noncalcified portions.

 

Figure 2
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  		Fig. 1B —60-year-old man with atypical chest pain. Average heart rate was 75.6 beats/min, and heart rate variability was 1.6 beats/min. Image quality of 64-MDCT coronary angiography was rated good to excellent in all segments. Invasive coronary angiogram corresponding to (A) confirms CT diagnosis of high-grade stenosis in proximal left anterior descending artery (arrow).

 

Figure 3
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  		Fig. 2A —56-year-old man with known coronary artery disease. Average heart rate was 66.1 beats/min and heart rate variability was 5.9 beats/min. Image quality of 64-MDCT coronary angiography was rated good in proximal and distal segments of right coronary artery (RCA). Curved planar CT image along centerline of RCA suggests presence of coronary stenosis in proximal RCA (arrowhead); severe blurring in middle segment (arrow) results in nonevaluable image quality (score 4).

 

Figure 4
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  		Fig. 2B —56-year-old man with known coronary artery disease. Average heart rate was 66.1 beats/min and heart rate variability was 5.9 beats/min. Image quality of 64-MDCT coronary angiography was rated good in proximal and distal segments of right coronary artery (RCA). Invasive coronary angiogram corresponding to A confirms presence of stenosis in proximal RCA and proves absence of significant coronary artery stenosis in mid RCA.

 

Figure 5
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  		Fig. 3 —Diagnostic accuracy in relation to average heart rate during CT. Linear regression plot shows overall diagnostic accuracy for assessment of coronary artery stenosis calculated for each patient as sum of true-positive and true-negative ratings divided by number of segments per patient. Dotted lines represent 95% confidence limits. Linear correlation indicates no significant dependence of diagnostic accuracy on average heart rate (Pearson r = -0.05, p = 0.79). Circles indicate individual patients represented by overall diagnostic accuracy (y-axis) plotted against average heart rate during scan acquisition (x-axis).

 

Figure 6
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  		Fig. 4 —Diagnostic accuracy in relation to variability of heart rate during CT. Linear regression plot shows overall diagnostic accuracy for assessment of coronary artery stenosis calculated for each patient as sum of true-positive and true-negative ratings divided by number of segments per patient. Dotted lines represent 95% confidence limits. Linear correlation indicates significant decrease in diagnostic accuracy with increasing heart rate variability (Pearson r = -0.61, p < 0.01). Circles indicate individual patients represented by overall diagnostic accuracy (y-axis) plotted against SD of heart rate during data acquisition (x-axis).

 

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