Journal of cardiovascular computed tomography · 2026
Optimal heart rate threshold for phase selection in beta-blocker-free coronary CT angiography using second-generation motion correction.
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Morikawa Tomoro, Sakai Rina, Saito Tatsuya, Matsuzaki Yuji, Namboku Takara, Nishii Tatsuya, Kotoku Akiyuki, Horinouchi Hiroki, Ohta Yasutoshi, Noguchi Teruo, Fukuda Tetsuya
Аннотация
PURPOSE: Beta-blocker-free coronary CT angiography (CCTA) improves workflow, but is often limited by motion artifacts at higher heart rates (HRs). Advances such as faster gantry rotation and second-generation motion correction (SSF2) may overcome these limitations. We aimed to determine the optimal HR cutoff for phase selection using SSF2.
METHODS: We retrospectively analyzed 368 patients who underwent CCTA without beta-blockers using a 256-row CT scanner (rotation time, 0.234 s). Systolic and diastolic phases were acquired over two consecutive heartbeats, with images reconstructed with and without SSF2. Image quality was graded on a 5-point Likert scale across seven coronary segments: proximal and distal portions of the three main coronary arteries and the left main trunk. Exams were deemed evaluable when all segments scored ≥3, allowing one distal segment to score 2. Receiver operating characteristic (ROC) curve analysis identified the optimal HR cutoff. Diagnostic performance for ≥50% stenosis was assessed in patients undergoing invasive coronary angiography (ICA).
RESULTS: Among 279 patients (median HR, 64 bpm), SSF2 significantly improved image quality and evaluability in both phases (all P < 0.001). The optimal HR cutoff was 67 bpm, yielding 91.8% evaluability. At HR ≤ 67 bpm, diastolic SSF2+ images were superior (P ≤ 0.01); at HR > 67 bpm, systolic SSF2+ images were optimal (P < 0.001). In 50 patients with ICA, HR-guided phase selection achieved sensitivity, specificity, and accuracy of 91.3%, 88.3%, and 89.0%, respectively.
CONCLUSION: SSF2 enabled reliable beta-blocker-free CCTA. An HR cutoff of 67 bpm effectively guided phase selection, achieving 91.8% evaluability.
METHODS: We retrospectively analyzed 368 patients who underwent CCTA without beta-blockers using a 256-row CT scanner (rotation time, 0.234 s). Systolic and diastolic phases were acquired over two consecutive heartbeats, with images reconstructed with and without SSF2. Image quality was graded on a 5-point Likert scale across seven coronary segments: proximal and distal portions of the three main coronary arteries and the left main trunk. Exams were deemed evaluable when all segments scored ≥3, allowing one distal segment to score 2. Receiver operating characteristic (ROC) curve analysis identified the optimal HR cutoff. Diagnostic performance for ≥50% stenosis was assessed in patients undergoing invasive coronary angiography (ICA).
RESULTS: Among 279 patients (median HR, 64 bpm), SSF2 significantly improved image quality and evaluability in both phases (all P < 0.001). The optimal HR cutoff was 67 bpm, yielding 91.8% evaluability. At HR ≤ 67 bpm, diastolic SSF2+ images were superior (P ≤ 0.01); at HR > 67 bpm, systolic SSF2+ images were optimal (P < 0.001). In 50 patients with ICA, HR-guided phase selection achieved sensitivity, specificity, and accuracy of 91.3%, 88.3%, and 89.0%, respectively.
CONCLUSION: SSF2 enabled reliable beta-blocker-free CCTA. An HR cutoff of 67 bpm effectively guided phase selection, achieving 91.8% evaluability.