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German cardiac CT registry: indications, procedural data and clinical consequences in 7061 patients undergoing cardiac computed tomography

  • Mohamed Marwan
  • Stephan Achenbach
  • Grigorios Korosoglou
  • Axel Schmermund
  • Steffen Schneider
  • Oliver Bruder
  • Jörg Hausleiter
  • Stephen Schroeder
  • Sebastian Barth
  • Sebastian Kerber
  • Alexander Leber
  • Werner Moshage
  • Jochen Senges
Original Paper

Abstract

Cardiac computed tomography permits quantification of coronary calcification as well as detection of coronary artery stenoses after contrast enhancement. Moreover, cardiac CT offers high-resolution morphologic and functional imaging of cardiac structures which is valuable for various structural heart disease interventions and electrophysiology procedures. So far, only limited data exist regarding the spectrum of indications, image acquisition parameters as well as results and clinical consequences of cardiac CT examinations using state-of-the-art CT systems in experienced centers. Twelve cardiology centers with profound expertise in cardiovascular imaging participated in the German Cardiac CT Registry. Criteria for participation included adequate experience in cardiac CT as well of the availability of a 64-slice or newer CT system. Between 2009 and 2014, 7061 patients were prospectively enrolled. For all cardiac CT examinations, patient parameters, procedural data, indication and clinical consequences of the examination were documented. Mean patient age was 61 ± 12 years, 63% were males. The majority (63%) of all cardiac CT examinations were performed in an outpatient setting, 37% were performed during an inpatient stay. 91% were elective and 9% were scheduled in an acute setting. In most examinations (48%), reporting was performed by cardiologists, in 4% by radiologists and in 47% of the cases as a consensus reading. Cardiac CT was limited to native acquisitions for assessment of coronary artery calcification in 9% of patients, only contrast-enhanced coronary CT angiography was performed in 16.6% and combined native and contrast-enhanced coronary CT angiography was performed in 57.7% of patients. Non-coronary cardiac CT examinations constituted 16.6% of all cases. Coronary artery calcification assessment was performed using prospectively ECG-triggered acquisition in 76.9% of all cases. The median dose length product (DLP) was 42 mGy cm (estimated effective radiation dose of 0.6 mSv). Coronary CT angiography was performed using prospectively ECG-triggered acquisition in 77.3% of all cases. Tube voltage was 120 kV in 67.8% of patients and 100 kV in 30.7% of patients, with a resultant median DLP of 256 mGy cm (estimated effective dose of 3.6 mSv). Clinical consequences of cardiac CT were as follows: in 46.8% of the cases, invasive coronary angiography could be avoided; ischemia testing was recommended in 4.7% of the cases, invasive coronary angiography was recommended in 16.4% of the cases and change in medication in 21.6% of the examinations. Cardiac CT is performed in the majority of patients for non-invasive evaluation of the coronary arteries. CT frequently resulted in medication change, and otherwise planned downstream testing including invasive angiography could be avoided in a high percentage of patients. Radiation exposure in experienced centers is relatively low.

Keywords

German Cardiac CT Registry 

Notes

Acknowledgements

The funding was supported by Stiftung für Herzinfarktforschung.

Compliance with ethical standards

Conflict of interest

Stephan Achenbach has received research grants from Siemens Healthcare and Abbott Vascular. Mohamed Marwan has received speaker honoraria from Siemens Healthcare and Edwards Lifesciences.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  • Mohamed Marwan
    • 1
  • Stephan Achenbach
    • 1
  • Grigorios Korosoglou
    • 2
  • Axel Schmermund
    • 3
  • Steffen Schneider
    • 4
  • Oliver Bruder
    • 5
  • Jörg Hausleiter
    • 6
  • Stephen Schroeder
    • 7
  • Sebastian Barth
    • 8
  • Sebastian Kerber
    • 8
  • Alexander Leber
    • 9
  • Werner Moshage
    • 10
  • Jochen Senges
    • 4
  1. 1.Cardiology DepartmentUniversity Hospital ErlangenErlangenGermany
  2. 2.GRN-Klinik WeinheimWeinheimGermany
  3. 3.Cardioangiologisches Centrum BethanienFrankfurtGermany
  4. 4.Stiftung Institut für Herzinfarkt ForschungLudwigshafenGermany
  5. 5.Klinik für Kardiologie und Angiologie Elisabeth KrankenhausEssenGermany
  6. 6.Medizinische Klinik und Poliklinik ILMU Klinikum der Universität MünchenMunichGermany
  7. 7.Klinik für Kardiologie, Pneumologie und Angiologie mit Schlaganfallstation, Internistische Sportmedizin, Alb Fils Klinik am Eichert Klinikum am EichertGöppingenGermany
  8. 8.Herz- und Gefäß-Klinik, Rhön-Klinikum Bad Neustadt an der SaaleBad Neustadt an der SaaleGermany
  9. 9.Isar Herz Zentrum MünchenMunichGermany
  10. 10.KardiologieKlinikum TraunsteinTraunsteinGermany

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