Calculating the heart rate cutoff that avoids motion artifacts with and without beta-blockers during 64-row coronary artery CT angiography

Abstract

Introduction

This study evaluates the establishment of specific heart rate (HR) cutoff values for coronary computed tomography angiography (CCTA) images obtained with and without the use of beta-blockers in a 64-row scanner.

Methods

The study included 399 patients, of whom 269 received beta-blockers and 130 did not. Patients with an HR exceeding 65 bpm were administered an additional dose of landiolol hydrochloride (CoreBeta; Ono, Osaka, Japan). HR was continuously monitored using a noninvasive cardiac output monitor (Aesculon mini; Ospyka Medical, Berlin, Germany). A total of 1197 randomized curved maximum intensity projection images were independently reviewed by observers for the presence or absence of motion artifacts in the CCTA images. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) and determine the optimal HR thresholds that maximized the sum of sensitivity and specificity for detecting motion artifacts.

Results

The optimal HR cutoff values were 76.6 bpm (AUC = 0.88, sensitivity = 83.0 %, specificity = 78.0 %) with beta-blockers, and 64.3 bpm (AUC = 0.91, sensitivity = 93.0 %, specificity = 86.0 %) without beta-blockers.

Conclusion

This study determined the optimal HR cut-off values for CCTA using a 64-row CT scanner, with and without beta-blockers, respectively. Future research should explore how evolving imaging technology and techniques influence optimal HR thresholds and image quality.

Implications for practice

Patients whose HR exceed 64.3 bpm during a CCTA scan, should be administered beta-blockers to lower HR to the level (≤64.3) that optimises image quality.