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Diagnosis of coronary artery disease in patients with atrial fibrillation using low tube voltage coronary CT angiography with isotonic low-concentration contrast agent

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Abstract

This prospective study evaluated the image quality and accuracy of coronary computed tomography angiography (CCTA) for diagnosing coronary artery disease (CAD) in patients with atrial fibrillation (AF), in which CCTA used adaptive iterative dose reduction (AIDR) with a low tube voltage and low concentration of isotonic contrast agent. Sixty-eight consecutive patients with AF and suspected CAD were equally and randomly apportioned to two groups and underwent CCTA. In the experimental group, the contrast agent was iodixanol (270 mg I/mL), patients were scanned with 100 kV, and reconstruction was by AIDR. In the conventional scanning (control) group, the contrast agent was iopromide (370 mg I/mL), patients were scanned with 120 kV, and reconstruction was by filtered back projection. The image quality, effective radiation dose (E), and total iodine intake of the groups were compared. Thirty-nine patients with coronary artery stenosis later were given invasive coronary angiography (ICA). The groups were similar with regard to mean CT value, noise, and signal-to-noise and contrast-to-noise ratios. The figure of merit of the experimental group was significantly higher than that of the control group, while the E and total iodine were significantly lower. Using ICA as the diagnostic reference, the groups shared similar sensitivity, specificity, and false positive and false negative rates for diagnosing coronary artery stenosis. For determining CAD in patients with AF, CCTA with isotonic low-concentration contrast agent and low-voltage scanning is a feasible alternative that improves accuracy and reduces radiation dose and iodine intake.

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Acknowledgements

This work was supported by the Huimin Project of Science and Technology of Ningbo City (2016C51013), the Project of Medical and Health Technology Program in Zhejiang Province (2018KY155), and the Research Foundation of Hwa Hospital, University of Chinese Academy of Science, China (2019HMKY41). The present study was supported by the Ningbo Science and Technology Innovation Team Program (2014B82002), the Fang Runhua Fund of Hong Kong, and the KC Wong Magna Fund of Ningbo University.

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  1. Yuning Pan and Qiuli Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Ningbo First Hospital, Ningbo, 305010, Zhejiang Province, People’s Republic of China

    Yuning Pan & Qiuli Huang

  2. Diabetes Research Center, School of Medicine, Ningbo University, 818 Fenghua Road, Jiangbei District, Ningbo, 315211, Zhejiang Province, People’s Republic of China

    Yingchao Zhu & Shizhong Bu

  3. Department of Endocrinology, Li Huili Easton Hospital of Ningbo Medical Center, Ningbo, 305040, Zhejiang Province, People’s Republic of China

    Xinrong Zou

  4. Department of Cardiology, Ningbo First Hospital, Ningbo, 305010, Zhejiang Province, People’s Republic of China

    Huimin Chu & Xianfeng Du

  5. Department of Radiology, Ningbo No. 2 Hospital, 41 Xibei Road, Haishu District, Ningbo, 305010, Zhejiang Province, People’s Republic of China

    Aijing Li

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  1. Yuning Pan
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Correspondence to Aijing Li or Shizhong Bu.

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Ethical approval

This prospective study was approved by the Ethics Committee of Ningbo First Hospital. All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all individual participants included in the study.

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Pan, Y., Huang, Q., Zhu, Y. et al. Diagnosis of coronary artery disease in patients with atrial fibrillation using low tube voltage coronary CT angiography with isotonic low-concentration contrast agent. Int J Cardiovasc Imaging 35, 2239–2248 (2019). https://doi.org/10.1007/s10554-019-01678-7

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