Dual-source coronary computed tomography angiography in patients with atrial fibrillation: initial experience

Wolak, Arik; Gutstein, Ariel; Cheng, Victor Y.; Suzuki, Yasuyuki; Thomson, Louise E.; Friedman, John; Dey, Damini; Hayes, Sean W.; Slomka, Piotr J.; Germano, Guido; Berman, Daniel S.

doi:10.1016/j.jcct.2008.03.003

« Previous Next »Journal of Cardiovascular Computed Tomography
Volume 2, Issue 3 , Pages 172-180, May 2008

Dual-source coronary computed tomography angiography in patients with atrial fibrillation: initial experience

Arik Wolak, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Dr. Wolak and Dr. Gutstein contributed equally to this work.
- Dr. Wolak and Dr. Gutstein are Save A Heart Foundation, Inc, fellows at Cedars Sinai Medical Center, Los Angeles, CA, and American Physicians Fellowship, Boston, MA.
Ariel Gutstein, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Dr. Wolak and Dr. Gutstein contributed equally to this work.
- Dr. Wolak and Dr. Gutstein are Save A Heart Foundation, Inc, fellows at Cedars Sinai Medical Center, Los Angeles, CA, and American Physicians Fellowship, Boston, MA.
Victor Y. Cheng, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Yasuyuki Suzuki, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Louise E. Thomson, MBChB
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
John Friedman, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
Damini Dey, PhD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
Sean W. Hayes, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Piotr J. Slomka, PhD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
Guido Germano, PhD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
Daniel S. Berman, MD
- Departments of Imaging and Medicine, and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Corresponding author.

Received 15 November 2007; accepted 19 March 2008. published online 25 March 2008.

Background

Patients with atrial fibrillation (AF) are generally excluded from coronary CT angiography (CCTA) studies because of motion artifact resulting from irregular rhythm. The 83-millisecond temporal resolution of the dual-source CT (DSCT) may be sufficient to allow CCTA in patients with AF.

Objective

We examined the feasibility of DSCT in patients with AF referred for CCTA.

Methods

We compared results of CCTA with DSCT in 24 consecutive patients with AF with 119 control patients in sinus rhythm. Standard relative-delay phase reconstruction (40%–80% of cardiac cycle) was used, with additional absolute delay reconstruction performed when indicated. Image quality was scored both subjectively and objectively.

Results

Patients with AF were older (68.5 ± 14.0 years versus 62.5 ± 12.1 years; P = 0.03). Maximum heart rate during injection was 102.5 ± 30.4 beats/min and 70.8 ± 16.6 beats/min in the AF and control groups, respectively (P < 0.01). Mean (±SD) Agatston score was 321 ± 366 (range, 0–1158) and 361 ± 743 (range, 0–3948) in the AF and control groups, respectively (P = 0.8). No difference was observed in the proportion of uninterpretable segments between the 2 groups, 7 (2%) in the AF group and 12 (1%) in the control group (P = NS). Two (8%) of 24 studies in the AF group and 12 (10%) of 119 studies in the control group were nondiagnostic (P = NS). Image quality was good or excellent in 13 (54%) of 21 AF cases compared with 94 (79%) of 119 control cases (P = 0.01). Absolute delay reconstruction was needed in 9 (38%) of 24 AF cases.

Conclusions

These preliminary data show that interpretable CCTA data can be obtained in patients with AF using DSCT. The need for absolute delay reconstruction is common.

Keywords: Angiography, Atrial fibrillation, Coronary computed tomography