Incremental Role of Cardiac CT Angiography in the Assessment of Left Ventricular Diastolic Function in Patients With Suspected Coronary Artery Disease With Normal Ejection Fraction: A Comparison With Transthoracic Echocardiography

IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Amy Fiona Suresh Kumar, Vineeta Ojha, Sreelal Thazhathu Veettil, Mohsin Mantoo, Damandeep Singh, Niraj Nirmal Pandey, Priya Jagia, Satyavir Yadav, Sanjeev Kumar
{"title":"Incremental Role of Cardiac CT Angiography in the Assessment of Left Ventricular Diastolic Function in Patients With Suspected Coronary Artery Disease With Normal Ejection Fraction: A Comparison With Transthoracic Echocardiography","authors":"Amy Fiona Suresh Kumar,&nbsp;Vineeta Ojha,&nbsp;Sreelal Thazhathu Veettil,&nbsp;Mohsin Mantoo,&nbsp;Damandeep Singh,&nbsp;Niraj Nirmal Pandey,&nbsp;Priya Jagia,&nbsp;Satyavir Yadav,&nbsp;Sanjeev Kumar","doi":"10.1111/echo.70069","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Diastolic dysfunction (DD) is defined as impaired left ventricular (LV) relaxation, caused by structural or functional heart diseases. We sought to assess the role of cardiac CT angiography (CCTA) as a tool to evaluate LV DD in patients with normal EF using the diastolic expansion index (DEI), as compared to transthoracic echocardiography (TTE) as the gold standard.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Patients presenting with atypical chest pain with suspected coronary artery disease (CAD) and having a normal LV ejection fraction on TTE underwent CCTA using a dual source CT scanner. Assessment of diastolic function on CCTA was done using DEI, and it was compared with TTE-derived diastolic function as per standard ASE/EACVI guidelines. DEI was measured using a dedicated postprocessing software (Syngo.via VB20, Siemens Healthcare, Germany) and was calculated as a ratio of maximum LV volume (in LV end-diastole) to maximum left atrial (LA) volume (in LV end-systole), with the mean value of readings from three independent readers taken for each calculation.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The study included 141 patients (60 male; mean age 50.82 ± 10.20 years; mean heart rate 84.90 ± 16.15 beats per minute). CCTA-derived mean indexed LA volumes correlated well with TTE measurements but were larger when compared to TTE (<i>r</i> = 0.53, <i>p</i> &lt; 0.0001). A progressive increase in LA volume index was noted with worsening DD grades. Excellent inter-observer correlation was seen between the three observers for LA volume index (intra-class correlation coefficient: 0.999 [95% CI: 0.999–0.999] and for DEI 0.996 [95% CI: 0.995–0.997]). A normal LV diastolic function was predicted by a DEI &gt; 1.57 with a specificity and sensitivity of 88.3% and 81.6%, respectively (area under curve (AUC)-0.87), whereas an abnormal LV diastolic function was predicted by DEI &lt;1.46 with a specificity and sensitivity of 84.8% and 62.5%, respectively (AUC-0.848). There was a significant correlation between the presence of obstructive CAD and an increase in calcium score with DD grade (<i>p</i> = 0.006 and 0.001, respectively).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>CCTA-derived DEI is a reliable metric for assessing LV diastolic dysfunction in patients with suspected CAD with normal ejection fraction. The presence of obstructive CAD and an increase in calcium score correlated with worsening DD grade.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 1","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/echo.70069","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Objective

Diastolic dysfunction (DD) is defined as impaired left ventricular (LV) relaxation, caused by structural or functional heart diseases. We sought to assess the role of cardiac CT angiography (CCTA) as a tool to evaluate LV DD in patients with normal EF using the diastolic expansion index (DEI), as compared to transthoracic echocardiography (TTE) as the gold standard.

Methods

Patients presenting with atypical chest pain with suspected coronary artery disease (CAD) and having a normal LV ejection fraction on TTE underwent CCTA using a dual source CT scanner. Assessment of diastolic function on CCTA was done using DEI, and it was compared with TTE-derived diastolic function as per standard ASE/EACVI guidelines. DEI was measured using a dedicated postprocessing software (Syngo.via VB20, Siemens Healthcare, Germany) and was calculated as a ratio of maximum LV volume (in LV end-diastole) to maximum left atrial (LA) volume (in LV end-systole), with the mean value of readings from three independent readers taken for each calculation.

Results

The study included 141 patients (60 male; mean age 50.82 ± 10.20 years; mean heart rate 84.90 ± 16.15 beats per minute). CCTA-derived mean indexed LA volumes correlated well with TTE measurements but were larger when compared to TTE (r = 0.53, p < 0.0001). A progressive increase in LA volume index was noted with worsening DD grades. Excellent inter-observer correlation was seen between the three observers for LA volume index (intra-class correlation coefficient: 0.999 [95% CI: 0.999–0.999] and for DEI 0.996 [95% CI: 0.995–0.997]). A normal LV diastolic function was predicted by a DEI > 1.57 with a specificity and sensitivity of 88.3% and 81.6%, respectively (area under curve (AUC)-0.87), whereas an abnormal LV diastolic function was predicted by DEI <1.46 with a specificity and sensitivity of 84.8% and 62.5%, respectively (AUC-0.848). There was a significant correlation between the presence of obstructive CAD and an increase in calcium score with DD grade (p = 0.006 and 0.001, respectively).

Conclusion

CCTA-derived DEI is a reliable metric for assessing LV diastolic dysfunction in patients with suspected CAD with normal ejection fraction. The presence of obstructive CAD and an increase in calcium score correlated with worsening DD grade.

求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
2.40
自引率
6.70%
发文量
211
审稿时长
3-6 weeks
期刊介绍: Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信