Cardiac Pearls - Learning

Cardiac

Prospective Gating

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Slides

Prospective Gating: Patient Selection
- Low and stable heart rate (ideally 65 bpm or less)
- <10 beats per minute of heart rate variability
- Can not be used if analysis of global or myocardial function is needed

How to use a prospective gated technique for cardiac CT
Earls JP
J Cardiovasc Comput Tomogr (2009) 3, 45-51
"By logistic regression, heart rate before CCTA of ≥ 70 beats/min, maximal heart rate variation before CCTA of ≥ 10 beats/min, coronary calcium score ≥ 400 U, and body mass index ≥ 30 were independent predictors of unsuccessful prospectively gated CCTA."

Predicting success of prospective and retrospective gating with dual source coronary computed tomography angiography: Development of selection criteria and initial experience
Gutstein A et al.
J Cardiovascular Comput Tomogr (2008) 2:81-90
"Prospectively gated CCTA with dual-source CT can be successfully implemented with consideration of prescan heart rate, heart rate variability, body mass index and coronary calcium score."

Predicting success of prospective and retrospective gating with dual source coronary computed tomography angiography: Development of selection criteria and initial experience
Gutstein A et al.
J Cardiovascular Comput Tomogr (2008) 2:81-90
Patient Selection
- BMI below 30 kg/m2
- heart rate below 70 BPM
- Low heart rate variation
- Agaston score below 400
"Dual-source step and shoot mode CT coronary angiography yielded diagnostic image quality for 97.9% of coronary segments at a low radiation dose."

Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose
Stolzmann P et al.
Radiology 2008; 249:71-80

"Dual-source (DS) CT coronary angiography in the step-and-shoot (SAS) mode can be performed in patients with a heart rate lower than 70 beats per minute and a body mass index (BMI) lower than 30 kg/mÂ², and it enabled diagnostic quality visualization of 97.9% of all coronary segments in the current study."

Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose
Stolzmann P et al.
Radiology 2008; 249:71-80

"Step and shoot mode DS CT coronary angiography with automated tube current modulation is associated with mean estimated effective dose of 2.6 mSv with the 120 kV protocol and 1.2 mSv with the 100 kV protocol."

Dual-Source CT in Step-and-Shoot Mode: Noninvasive Coronary Angiography with Low Radiation Dose
Stolzmann P et al.
Radiology 2008; 249:71-80