A 66-year-old male patient who had undergone allogenic heart transplantation 16 years ago was referred to non-invasive coronary angiography for the exclusion of significant coronary artery stenoses.
The mean heart rate during examination was 102 beats per minute (bpm), no administration of beta blockers was performed prior to the scan. After calculation of the contrast transit time using a test bolus approach, coronary CT-Angiography was performed in craniocaudal direction injecting 65 ml of iodine contrast agent followed by a 50 ml saline chaser, both at 5 ml/s. Due to the relatively high heart rate a pitch of 0.39 was chosen, resulting in scan time of 7 seconds.
A systolic reconstruction at 40 % of the RR-cycle provided the artifact-free visualization and allowed the exclusion of significant stenoses and plaque burden in the Left Artery Descending and the Ramus Circumflex. Even the Right Coronary Artery, which is frequently affected by motion artifacts at heart rates of more than 60 bpm, could be visualized in its entire course without artifacts.
In conclusion, this case confirms the ability of DSCT to visualize coronary artery lumina without motion artifacts independent from the patient‘s heart rate and without precedent heart rate lowering medication.
Fig. 1: Artefact-free VRT visualization of Left Artery Descending and Ramus Circumflex.
Fig. 2: Exclusion of significant stenoses and plaque burden in Left Artery Descending.
Fig. 3: Exclusion of significant stenoses and plaque burden in right coronary artery.
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