Aims The primary aim of this audit was to assess for the presence of delays in outpatient Computed Tomography Cardiac Angiography (CTCA) workflow, defined as greater than 90 minutes from administration of pre-medication to image acquisition. The secondary aims were to identify for potential causes of delay and to assess the impact of delays on acquisition heart rate during CTCA.

Background Computed Tomography Cardiac Angiography (CTCA) is a non-invasive and well-recognised imaging technique utilised in the investigation of chest pain in patients with low to intermediate risk of acute coronary syndrome. It provides useful information regarding coronary anatomy, severity of coronary artery luminal stenoses, non-coronary cardiac and thoracic findings 1. The relationship between patient heart rate and image quality and subsequent interpretability is well established in literature 2-6. Administration of rate control agents such as beta-blockers or ivabradine, via the oral or intravenous route, is...

Results There were 109 outpatient CTCA examinations conducted during the audit period. 55 were excluded and a total of 54 examinations were included in the final data set. General descriptive statistics were generated from the data set. This included time from prescription to administration of pre-medication, time from administration to scan, and heart rate before and during radiographic examination. These are depicted in Table 1 and Table 2. Heart rate values (above and below 65bpm) were tallied within their respective groups (delay or non-delay). Fischer...

Discussion The presence of delay was associated with a greater number of suboptimal heart rates and motion artefacts during acquisition, although this did not reach statistical significance. Despite the significant proportion of delays, 80% of heart rates in the delay group remained under 65bpm and did not appear to affect study interpretation. Whilst acknowledging the relatively small sample size of this audit, these results do concur with the available literature on the pharmacokinetics of rate control agents utilised. Considering that peak plasma concentrations of oral...

Leipsic J, Abbara S, Achenbach S, Cury R, Earls J, Mancini G, et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. Journal of Cardiovascular Computed Tomography. 2014;8(5):342-358. Giesler T, Baum U, Ropers D, Ulzheimer S, Wenkel E, Mennicke M, et al. Noninvasive Visualization of Coronary Arteries Using Contrast-Enhanced Multidetector CT: Influence of Heart Rate on Image Quality and Stenosis Detection. American Journal of Roentgenology. 2002;179(4):911-916. Yang C, Law W, Lu...