Body physique and heart rate variability determine the occurrence of stair-step artefacts in 64-slice CT coronary angiography with prospective ECG-triggering

The purpose of this study was to describe and characterize the frequency and extent of stair-step artefacts in computed tomography coronary angiography (CTCA) with prospective electrocardiogram (ECG)-triggering and to identify their determinants. One hundred and forty three consecutive patients (55 women, mean age 57 ± 13 years) underwent 64-slice CTCA using prospective ECG-triggering. Occurrence of stair-step artefacts in CTCA of the thoracic wall and the coronary arteries was determined and maximum offset was measured. If stair-step artefacts occurred in both cases, a difference between thoracic wall and coronary artery offset of 0.6 mm or greater was attributed to additional motion of the heart. Mean effective radiation dose was 2.1 ± 0.7 mSv (range 1.0–3.5 mSv). Eighty-nine patients (62%) had stair-step artefacts in CTCA of the coronary arteries (mean offset of 1.7 ± 1.1 mm), while only 77 patients had thoracic wall stair-step artefacts (mean offset of 1.0 ± 0.3 mm; significantly different, P < 0.001). Stair-step artefacts in CTCA of the thoracic wall were determined by BMI and weight (P < 0.01), while artefacts in CTCA of the coronary arteries were associated with heart rate variability (P < 0.05). Stair-step artefacts in CTCA with prospective ECG-triggering are determined by (a) motion of the entire patient during table travel, particularly in large patients and (b) by motion of the heart, particularly when heart rates are variable.