Incremental Diagnostic Value of Regional Left Ventricular Function Over Coronary Assessment by Cardiac Computed Tomography for the Detection of Acute Coronary Syndrome in Patients With Acute Chest Pain

Abstract

Background The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain. Methods and Results We analyzed 356 patients (mean age 53±12 years, 62% male) with acute chest pain and inconclusive initial ED evaluation. Patients underwent 64-slice contrast-enhanced cardiac CT prior to hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50%) were separately assessed by two independent readers. Incremental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive CAD, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74% (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10% increase in sensitivity to detect ACS by cardiac CT (87%, 95%-confidence interval [CI]: 70–96%) and significantly improved the overall accuracy (c-statistic: 0.88 vs. 0.94 and 0.79 vs. 0.88, for extent of plaque and presence of stenosis; respectively; both p<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89% sensitivity and 86% specificity in patients with significant stenosis (n=33) and 60% sensitivity and 86% specificity in patients with inconclusive coronary CTA (n=33). Conclusions Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS. Clinical Trial Registration URL: http://clinicaltrials.gov/ct2/show/NCT00990262. Unique Identifier: NCT00990262

Performance of Automated Software in the Assessment of Segmental Left Ventricular Function in Cardiac CT: Comparison with Cardiac Magnetic Resonance

“…In addition, the application of a 10-phase image reconstruction in CCT is sufficient to provide a reliable evaluation of the segmental LV function, as previously reported by Ko et al [9] for LV volumes and EF. Abnormalities of regional LV wall motion are important markers of myocardial ischemia [8] and improve diagnostic accuracy for acute coronary syndrome (ACS) in patients with acute chest pain, and, thus, may be helpful to guide further management in patients at intermediate risk for ACS [1]. Moreover, in patients undergoing CCT for detection of CAD, a measurement of LVEF can be used as an alternative method, particularly in case of equivocal or suboptimal echocardiography.…”

“…Measurement of left ventricular (LV) function is a wellestablished clinical parameter that has fundamental diagnostic, therapeutic, and prognostic implications for coronary artery disease (CAD) [1]. Echocardiography is the most utilized technique in clinical practice for the assessment of LV function despite the fact that it remains an operator-dependent modality, which is usually limited by poor reproducibility and its potential impairment due to an inadequate acoustic window [2].…”

Dose levels and image quality of second-generation 128-slice dual-source coronary CT angiography in clinical routine

“…Seneviratne et al [29] also highlighted the importance of assessing left ventricular function as it may improve the diagnostic accuracy for acute coronary syndrome in patients with acute chest pain.…”

The potential role for the use of cardiac computed tomography angiography for the acute chest pain patient in the emergency department

“…58 Further analyses of the study looking at predefined age-and gender-specific patient categories, regional left ventricular function and aortic valve calcification suggest that incremental diagnostic value gathered from CCTA may further help improve the diagnostic accuracy of this study when used in the emergency department. [59][60][61] Findings such as these are proof-of-principle data that demonstrate the feasibility of use of cardiac CT to provide a direct non-invasive visualization of coronary anatomy while correctly identifying patients at risk for MACE. If a patient is found to have a negative study they are at extremely low risk for future events.…”