Computerized left ventricular regional ejection fraction analysis for detection of ischemic coronary artery disease with multidetector CT angiography

Abstract

Regional ejection fraction (REF) provides important functional information of the left ventricular regional myocardium. We aimed to test the diagnostic accuracy of computerized REF analysis for detecting the ischemia and significant stenosis with multidetector CT angiography (MDCT). This is a retrospective study including 155 patients who underwent MDCT scans for evaluation of coronary artery disease. Among them, 83 patients also underwent SPECT imaging and invasive coronary angiography (ICA). Two groups of patients were defined: Control group with 0 coronary artery calcium and normal global and regional ventricular function, and comparison group. REF measurement was performed on all patients using computerized software. Control group REF measurements will be used as reference standard (mean-2SD REF/mean global ejection fraction) to define abnormal REF. The sensitivity, specificity, positive and negative predictive value of REF in detecting perfusion defects (fixed and reversible) was 73, 80, 75 and 79 % respectively, in a patient based analysis of comparison group. The diagnostic accuracy of REF in predicting significant stenosis (>50 %) on ICA compared with SPECT was 72 versus 61 % and 85 versus 79 % in patient and vessel based analysis of comparison group, respectively. ROC curve analysis showed REF to be a better predictor of perfusion defects on SPECT compared with significant stenosis (>50 %) alone or stenosis combined with REF (P < 0.05). The computerized assessment of REF analysis is comparable to SPECT in predicting ischemia and a better predictor of significant stenosis than SPECT. This study also provides reference standard to define abnormal values.

Does Transendocardial Injection of Mesenchymal Stem Cells Improve Myocardial Function Locally or Globally?

“…For regional analysis of myocardial function, previous studies 18 , using electron beam computed tomography (EBCT), demonstrated that SEF can detect abnormalities and provide accurate identification of ischemic myocardium in patients with varying degrees of coronary artery occlusion. Similarly, by applying the principle of SEF to regenerative myocardial therapy, we have been able to analyze regional myocardial performance and scarring following TESI in patients with chronic ischemic cardiomyopathy (Online Figure II).…”

“…SEF is an expression of regional function, reflecting the volume of blood ejected under a given myocardial segment, contributing to the global LVEF 18 . The left anterior descending (LAD) artery in the interventricular sulcus between the basal anterior (AHA seg #1) and the basal anteroseptal (AHA seg #2) segments in the short axis view was used as an anatomical landmark for segmentation.…”

Regional ejection fraction and regional area strain for left ventricular function assessment in male patients after first-time myocardial infarction

“…The REF is usually computed using either CMR images or multi-detector computed tomography (CT) images [7][8][9][10]. The partitioning of the LV from the images is based on the 17-segment model that was introduced by Cerqueira et al in 2002 [11].…”

“…However, the methodology of calculating the REF has not been standardized and different groups adopt slightly different methods in computing this index. For example, Zeb et al [9] used a floating point method for partitioning the LV in order to compute the REF, whereas Masci et al [10] used a fixed point method. The differences in both methods pertain to the definition of the basal-apical axis from the images.…”

Assessment of infarct-specific cardiac motion dysfunction using modeling and multimodal magnetic resonance merging

“…The REF has been used as a regional function index in several studies to describe the specific contributions of remote and infarct sectors, which could not be measured with the global functional assessment approach . The excellent correlation between α ES and REF demonstrated the feasibility of using regional functional quantification by merging the MRI data of different modalities.…”