Left Atrium Measurements via Computed Tomography Pulmonary Angiogram as a Predictor of Diastolic Dysfunction

Lick, Adam N.; Danrad, Raman; Smith, David L.; Lammi, Matthew R.

doi:10.1097/rct.0000000000000597

Cited by 8 publications

(10 citation statements)

References 26 publications

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“…In comparison diameter measurements of the LV, RV, and LA as well as ratios of diameter measurements showed lower diagnostic performances to diagnose HF. For these parameters, LA diameter had the highest AUC, which is compatible with previous studies [ 22 ].…”

Section: Discussionsupporting

confidence: 91%

“…One reader (C.R., 1 year of experience in radiology) performed diameter measurements of the LV, RV, and left atrium (LA) as previously described [ 21 , 22 ]. LV and RV diameters were measured at their widest point at the midventricular level, on the same CT axial image (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…LA size was measured using the maximum anterior-posterior diameter in its middle 50% (Fig. 3B ) [ 22 ].

Fig.…”

Section: Methodsmentioning

confidence: 99%

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Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

et al. 2022

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Objectives To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. Methods In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. Results Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980–0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82–0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81–0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively. Conclusion In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF. Key Points • Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

et al. 2022

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“…Our study not only provides confirmatory evidence for the diagnostic accuracy of LA volume in a different institution and patient cohort but also demonstrates its superiority compared to LA axial anteroposterior diameter in an intra-individual comparison. LA anteroposterior diameter is the most widely used LA measurement in clinical practice and PH research in both echocardiography and CT according to international recommendations and literature [ 7 , 19 , 27 – 30 ]. Previous studies reported AUC values of 0.71–0.83 for identification of group 2 PH by LA anteroposterior diameter, compared to 0.83 in our study cohort [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…LV and RV diameters were measured perpendicular to the interventricular septum on the slice on which the respective ventricle appeared largest [18]. LA diameter was determined as the largest anterior-posterior-diameter on the slice in the middle 50% of the craniocaudal extension of the left atrium [19]. RA diameter was measured as the largest diameter parallel to the tricuspid valve plane, excluding right atrial appendage and coronary sinus [20].…”

Section: Image Analysismentioning

confidence: 99%

Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease

et al. 2022

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Objectives To assess diagnostic accuracy of automated 3D volumetry of cardiac chambers based on computed tomography pulmonary angiography (CTPA) for the differentiation of pulmonary hypertension due to left heart disease (group 2 PH) from non-group 2 PH compared to manual diameter measurements. Methods Patients with confirmed PH undergoing right heart catheterisation and CTPA within 100 days for diagnostic workup of PH between August 2013 and February 2016 were included in this retrospective, single-centre study. Automated 3D segmentation of left atrium, left ventricle, right atrium and right ventricle (LA/LV/RA/RV) was performed by two independent and blinded radiologists using commercial software. For comparison, axial diameters were manually measured. The ability to differentiate group 2 PH from non-group 2 PH was assessed by means of logistic regression. Results Ninety-one patients (median 67.5 years, 44 women) were included, thereof 19 patients (20.9%) classified as group 2 PH. After adjustment for age, sex and mean pulmonary arterial pressure, group 2 PH was significantly associated with larger LA volume (p < 0.001), larger LV volume (p = 0.001), lower RV/LV volume ratio (p = 0.04) and lower RV/LA volume ratio (p = 0.003). LA volume demonstrated the highest discriminatory ability to identify group 2 PH (AUC, 0.908; 95% confidence interval, 0.835–0.981) and was significantly superior to LA diameter (p = 0.009). Intraobserver and interobserver agreements were excellent for all volume measurements (intraclass correlation coefficients 0.926–0.999, all p < 0.001). Conclusions LA volume quantified by automated, CTPA-based 3D volumetry can differentiate group 2 PH from other PH groups with good diagnostic accuracy and yields significantly higher diagnostic accuracy than left atrial diameter. Key Points • Automated cardiac chamber volumetry using non-gated CT pulmonary angiography can differentiate pulmonary hypertension due to left heart disease from other causes with good diagnostic accuracy. • Left atrial volume yields significantly higher diagnostic accuracy than left atrial axial diameter for identification of pulmonary hypertension due to left heart disease without time-consuming manual processing.

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Noninvasive assessment of pulmonary hypertension: key insights to maximize chest computed tomography

Nardone,

Minichetti,

Sauro

et al. 2024

J Med Imaging Intervent Radiol

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According to the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines, a right heart catheterization-derived mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest defines pulmonary hypertension (PH). As PH can ultimately lead to death, multidisciplinary early diagnosis, proper framework, and prompt management are crucial. ESC/ERS PH classification encompasses five groups, each sharing pathogenesis, hemodynamics, and management, i.e., group I, pulmonary arterial hypertension; II, left heart disease; III, lung disease and/or hypoxia; IV, chronic thromboembolic PH; and V, with unclear and/or multifactorial mechanisms. Chest CT is pivotal in PH grouping, comprehensively evaluating the lung, heart, pulmonary vessels, and mediastinum. In this review, we synoptically illustrate the chest CT findings of PH and provide a CT-based logical framework suggesting a PH group hypothesis. Improving knowledge of PH CT features and their combination empowers radiologists to contribute valuably to the PH multidisciplinary clinical discussion.

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Left Atrium Measurements via Computed Tomography Pulmonary Angiogram as a Predictor of Diastolic Dysfunction

Cited by 8 publications

References 26 publications

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease

Noninvasive assessment of pulmonary hypertension: key insights to maximize chest computed tomography

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