The influence of clinical and acquisition parameters on the interpretability of adenosine stress myocardial computed tomography perfusion

<span class="paragraphSection"><div class="boxTitle">Aims</div>The interpretation of adenosine stress myocardial computed tomography perfusion (CTP) is often hampered by image artefacts caused by cardiac motion, beam hardening, and cone beam. The aim of the present analysis was to assess the influence of the heart-rate response during adenosine infusion, patient characteristics, and medication use on the interpretability of stress myocardial CTP examinations.<div class="boxTitle">Methods and results</div>Interpretability of stress myocardial CTP examinations was evaluated in 120 patients who underwent sequentially coronary CTA and adenosine stress myocardial CTP (320-row CT scanner, temporal resolution 175 ms) and scored as follows: excellent = absence of any artefact (<span style="font-style:italic;">n</span> = 27, 22%); good = presence of artefacts that do not interfere with the study interpretability (<span style="font-style:italic;">n</span> = 56, 47%); fair = artefacts that do interfere with interpretability (<span style="font-style:italic;">n</span> = 35, 29%); poor = uninterpretable study due to artefacts (<span style="font-style:italic;">n</span> = 2, 2%). ‘Fair’ and ‘poor’ were merged into ‘reduced’ for comparisons. Increasing heart rate during stress myocardial CTP acquisition was related to worse interpretability (excellent: 61.7 ± 13.4 bpm vs. good: 69.8 ± 13.5 bpm vs. reduced: 78.1 ± 17.0 bpm, <span style="font-style:italic;">P</span> < 0.001). Thirteen (11%) of all examinations were considered non-diagnostic. In patients with a heart rate exceeding 85 bpm, 76% of the studies were ‘reduced’ interpretable. In multivariate analysis, no use of beta blocker (baseline or additional use prior to coronary CTA) (OR: 0.2, <span style="font-style:italic;">P</span> = 0.012), increasing heart rate during coronary CTA (OR: 1.09, <span style="font-style:italic;">P</span> = 0.032), younger age (OR: 0.92, <span style="font-style:italic;">P</span> = 0.021), and the use of calcium antagonist (OR: 6.48, <span style="font-style:italic;">P</span> = 0.017) were independently associated with a heart rate ≥85 bpm during stress myocardial CTP.<div class="boxTitle">Conclusion</div>Higher heart rate during the acquisition of stress myocardial CTP was related to worse interpretability. Furthermore, increasing heart rate during and no beta blocker use prior to the previously performed coronary CTA, younger age, and the use of calcium antagonist were independently associated with a heart rate ≥85 bpm during stress myocardial CTP acquisition.</span>

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