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Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: a systematic review and meta-analysis

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Abstract

To perform a systematic review and meta-analysis of the diagnostic value of prospective ECG-gating coronary CT angiography in the diagnosis of coronary artery disease. A search of biomedical databases for English literature was performed to identify studies investigating the diagnostic value of 64- or more slice CT angiography with use of prospective ECG-gating in the diagnosis of coronary artery disease. Sensitivity, specificity, positive and negative predictive value estimates pooled across studies were tested using a fixed effects model. Fourteen studies met selection criteria for inclusion in the analysis. Pooled estimates and 95% confidence interval (CI) of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography for diagnosis of significant coronary stenosis were 99% (95% CI: 98, 100%), 91% (95% CI: 88, 94%), 94% (95% CI: 91, 96%) and 99% (95% CI: 97, 100%), according to the patient-based assessment. The mean values of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography were 95% (95% CI: 93, 96%), 95% (95% CI: 93, 95%), 88% (95% CI: 86, 90%), and 98% (95% CI: 97, 98%), according to vessel-based assessment; 92% (95% CI: 90, 93%), 97% (95% CI: 97, 98%), 84% (95% CI: 82, 86%), 99% (95% CI: 99, 99%), according to segment-based assessment, respectively. The mean effective dose was 3.3 mSv (95% CI: 2.3, 4.1 mSv) for the prospective ECG-gating coronary CT angiography. This analysis shows that for a predominantly male population with a high disease prevalence the use of coronary CT angiography with prospective ECG gating allows for a reduced radiation exposure without a sacrifice in diagnostic efficacy.

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References

  1. Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of non-invasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557

    Article  PubMed  Google Scholar 

  2. Feng Q, Yin Y, Hua X, Zhu R, Hua J, Xu J (2010) Prospective ECG triggering versus low-dose retrospective ECG-gated 128-channel CT coronary angiography: comparison of image quality and radiation dose. Clin Radiol 65:809–814

    Article  PubMed  CAS  Google Scholar 

  3. Kitagawa K, Lardo AC, Lima JAC, George RT (2009) Prospective ECG-gated 320 row detector computed tomography: implications for CT angiography and perfusion imaging. Int J Cardiovasc Imaging 25:201–208

    Article  Google Scholar 

  4. Ribicki FJ, Otero HJ, Steigner ML et al (2008) Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 24:535–546

    Article  Google Scholar 

  5. Fazel R, Krumholz HM, Wang YF et al (2009) Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 361:849–857

    Article  PubMed  CAS  Google Scholar 

  6. Paul JF, Abada HT (2007) Strategies for reduction of radiation dose in cardiac multislice CT. Eur Radiol 17:2028–2037

    Article  PubMed  Google Scholar 

  7. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284

    Article  PubMed  CAS  Google Scholar 

  8. Hausleiter J, Meyer T, Hermann F et al (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301(5):500–507

    Article  PubMed  CAS  Google Scholar 

  9. Raff GL, Chinnaiyan KM, Share DA et al (2009) Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA 301:2340–2348

    Article  PubMed  CAS  Google Scholar 

  10. Sun Z, Ng KH (2010) Multislice CT angiography in cardiac imaging. Part III: radiation risk and dose reduction. Singap Med J 51:374–380

    CAS  Google Scholar 

  11. Sun Z, Ng KH (2011) Prospective versus retrospective ECG-gated multislice CT coronary angiography: a systematic review of radiation dose and image quality. Eur J Radiol (Epub ahead or print). doi:10.1016/j.ejrad.2011.01.070

  12. Achenbach S, Marwan M, Ropers D et al (2010) Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 31:340–346

    Article  PubMed  Google Scholar 

  13. Lell MM, Marvan M, Schepis T et al (2009) Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience. Eur Radiol 19:2576–2583

    Article  PubMed  Google Scholar 

  14. von Ballmoos MY, Haring B, Juillert P, Alkadhi H (2011) Meta-analysis: diagnostic performance of low-radiation-dose coronary computed tomography angiography. Ann Intern Med 154:413–420

    Google Scholar 

  15. Hsieh J, Londt J, Vass M, Li J, Tang X, Okerlund D (2006) Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography. Med Phys 33:4236–4248

    Article  PubMed  Google Scholar 

  16. Whiting P, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536

    PubMed  Google Scholar 

  17. Stolzmann P, Scheffel H, Leschka S et al (2008) Influence of calcification on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. Am J Roentgenol 191:1684–1689

    Article  Google Scholar 

  18. Scheffel H, Alkadhi H, Leschka S et al (2008) Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart 94:1132–1137

    Article  PubMed  CAS  Google Scholar 

  19. Herzog BA, Husmann L, Burkhard N et al (2008) Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience. Eur Heart J 29:3037–3042

    Article  PubMed  Google Scholar 

  20. Herzog BA, Wyss CA, Husmann L et al (2009) First head-to-head comparison of effective radiation dose from low-dose 64-slice CT with prospective ECG-triggering versus invasive coronary angiography. Heart 95:1656–1661

    Article  PubMed  CAS  Google Scholar 

  21. Pontone G, Andreini D, Bartoreli A et al (2009) Diagnostic accuracy of coronary computed tomography angiography: a comparison between prospective and retrospective electrocardiogram triggering. J Am Coll Cardiol 54:346–355

    Article  PubMed  Google Scholar 

  22. Maruyama T, Takada M, Hasuike T, Yoshikawa A, Namimatsu E, Yoshizumi T (2008) Radiation dose reduction and coronary assessability of prospective electrocardiogram-gated computed tomography coronary angiography: Comparison with retrospective electrocardiogram-gated helical scan. J Am Coll Cardiol 52:1450–1455

    Article  PubMed  Google Scholar 

  23. La Bounty TM, Leipsic J, Mancini J et al (2010) Effect of a standardized radiation dose reduction protocol on diagnostic accuracy of coronary computed tomographic angiography. Am J Cardiol 106:287–292

    Article  Google Scholar 

  24. Dewey M, Zimmermann E, Deissenrieder F et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875

    Article  PubMed  Google Scholar 

  25. Carrascoca P, Capunay C, Deviggiano A et al (2010) Accuracy of low-dose prospectively gated axial coronary CT angiography for the assessment of coronary artery stenosis in patients with stable heart rate. J Cardiovasc Comput Tomogr 4:197–205

    Article  Google Scholar 

  26. Alkadhi H, Stolzmann P, Desbiolles L et al (2010) Low-dose, 128-slice, dual-source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode. Heart 96:933–938

    Article  PubMed  Google Scholar 

  27. de Graaf FR, Schuijf JD, van Velzen JE et al (2010) Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur Heart J 31:1908–1915

    Article  PubMed  Google Scholar 

  28. Husmann L, Herzog BA, Burger IA et al (2010) Usefulness of additional coronary calcium scoring in the low-dose CT coronary angiography with prospective ECG-triggering. Acad Radiol 17:201–206

    Article  PubMed  Google Scholar 

  29. Lu B, Lu JG, Sun ML et al (2011) Comparison of diagnostic accuracy and radiation dose between prospective triggering and retrospective gated coronary angiography by dual-source computed tomography. Am J Cardiol 107:1278–1284

    Article  PubMed  Google Scholar 

  30. Stolzmann P, Goetti R, Baumueller S et al (2011) Prospective and retrospective ECG-gating for CT coronary angiography perform similarly accurate at low heart rates. Eur J Radiol 79:85–91

    Article  PubMed  Google Scholar 

  31. Scheffel H, Stolzmann P, Alkadhi H et al (2010) Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches. Int J Cardiovasc Imaging 26:579–590

    Article  PubMed  Google Scholar 

  32. Donati OF, Stolzmann P, Desbiolles L et al (2011) Coronary artery disease: which degree of coronary artery stenosis is indicative of ischemia? Eur J Radiol (Epub ahead of print). doi:10.1016/j.ejrad.2010.07.010

  33. Chao SP, Law WY, Kuo CJ et al (2010) The diagnostic accuracy of 256-row computed tomographic angiography compared with invasive coronary angiography in patients with suspected coronary artery disease. Eur Heart J 31:1916–1923

    Article  PubMed  Google Scholar 

  34. Hong YJ, Kim SJ, Lee SM et al (2011) Low-dose coronary computed tomography angiography using prospective ECG-triggering compared to invasive coronary angiography. Int J Cardiovasc Imaging 27:425–431

    Article  PubMed  Google Scholar 

  35. Korosoglou G, Mueller D, Lehrke S et al (2010) Quantitative assessment of stenosis severity and atherosclerotic plaque composition using 256-slice computed tomography. Eur Radiol 20:1841–1850

    Article  PubMed  Google Scholar 

  36. Bongartz G, Golding SJ, Jurik AJ (2004) et al. (2004) European guidelines for multislice computed tomography: report EUR 16262 EN. European Commission, Luxembourg

    Google Scholar 

  37. Morin RL (1988) Monte Carlo simulation in the radiological sciences. CRC Press, Boca Raton

    Google Scholar 

  38. Sun Z, Lin CH, Davidson R, Dong C, Liao Y (2008) Diagnostic value of 64-slice CT angiography in coronary artery disease: a systematic review. Eur J Radiol 67:78–84

    Article  PubMed  Google Scholar 

  39. Abdulla J, Abildstrom Z, Gotzsche O et al (2007) 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J 28:3042–3050

    Article  PubMed  Google Scholar 

  40. Vanhoenacker P, Heijenbrok-Kal M, Van Heste R et al (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428

    Article  PubMed  Google Scholar 

  41. Mowatt G, Cook JA, Hillis GS et al (2008) 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393

    Article  PubMed  CAS  Google Scholar 

  42. Shuman WP, Branch KR, May JM et al (2009) Whole-chest 64-MDCT of emergency department patients with nonspecific chest pain: radiation dose and coronary artery image quality with prospective ECG triggering versus retrospective ECG gating. AJR Am J Roentgenol 192:1662–1667

    Article  PubMed  Google Scholar 

  43. Arnoldi E, Johnson TR, Rist C et al (2009) Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques. Eur Radiol 19:2147–2155

    Article  PubMed  Google Scholar 

  44. Pflederer T, Rudofsky L, Ropers D et al (2009) Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenol 192:1045–1050

    Article  PubMed  Google Scholar 

  45. Leschka S, Stolzmann P, Schmid F et al (2008) Low kilovoltage cardiac dual-source CT: attenuation, noise and radiation dose. Eur Radiol 18:1809–1817

    Article  PubMed  Google Scholar 

  46. Lau J, Ioannidis JP, Schmid CH (1998) Summing up evidence: one answer is not always enough. Lancet 351:123–127

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank Mr Gil Stevenson for his assistance in the statistical analysis of results.

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Authors and Affiliations

  1. Curtin University, Perth, Australia

    Zhonghua Sun

  2. University of Malaya, Kuala Lumpur, Malaysia

    Kwan-Hoong Ng

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  1. Zhonghua Sun
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Correspondence to Zhonghua Sun.

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Sun, Z., Ng, KH. Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: a systematic review and meta-analysis. Int J Cardiovasc Imaging 28, 2109–2119 (2012). https://doi.org/10.1007/s10554-011-0006-0

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