Impact of heart rate on interscan variability in coronary artery calcium scoring

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Abstract Background Low variability in consecutive coronary artery calcium (CAC) scoring is crucial, particularly when assessing CAC progression. Purpose To assess the impact of heart rate (HR) differences on the interscan variability. Materials and Methods We prospectively enrolled 295 patients referred for CAC scoring. Each patient underwent two consecutive non-contrast-enhanced ECG-triggered CT scans. Intravenous beta-blocker was administered after the first scan if the HR was ≥65 beats per minute (bpm) to achieve a HR < 65 bpm during the second scan. HR was recorded during the first (HR1) and second (HR2) CT scan, and CAC scores were derived from the first (CACS1) and second (CACS2) scan. Differences in HR (ΔHR) and CAC scores (ΔCACS) and interscan variability among ΔHR terciles were calculated. Results Two-hundred-and-ninety-five patients (81% male, median age 60 [IQR 53–68] years) were analyzed. Median HR1 was significantly higher than HR2 (63 [IQR 57–71] bpm vs. 59 [IQR 55–63] bpm, P < 0.01). Median ΔHR was 5 [IQR 0–10] bpm. Overall median CACS1 and CACS2 were not significantly different (51 [IQR 5–238] vs. 51 [IQR 5–227], P = 0.532). Median ΔCACS was 4 [IQR 0–16]. There was no significant difference in ΔCACS between ΔHR groups 0–1 and >1 bpm ( P = 0.465). Risk reclassification occurred in 6% of patients, predominantly within lower risk classes, with no significant difference between ΔHR groups ( P = 0.15). Conclusion Elevated HR and resulting motion artifacts can lead to increased interscan CAC variability, particularly in patients with very high CAC scores. However, these fluctuations do not result in clinically significant differences.

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