We evaluated the determinants of vessel contrast in prospectively ECG-triggered CT coronary angiography (CTCA). Seventy patients underwent low-dose CTCA using body mass index (BMI)-adapted tube parameters and a fixed contrast material bolus. Contrast to noise ratio (CNR) was calculated from contrast (between coronaries and perivascular tissue) and image noise (standard deviation of aortic attenuation). Cardiac output (CO) was calculated from gated (99m)Tc-tetrofosmin-SPECT. Mean radiation dose was 2.13 +/- 0.69 mSv. Image noise was not affected by BMI (r = 0.1, P = 0.36), while CNR was inversely related to body surface area (BSA) (r = -0.5, P < 0.001) and CO (r = -0.45, P < 0.001). After successfully overcoming the impact of BMI on image noise by adapting tube parameters, CNR mainly depends on coronary vessel contrast. The latter reflects the dilution of the contrast material by blood volume and CO, which are both correlated to BSA. Therefore, BSA adapted contrast administration may help to compensate for this effect.