Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function

Q: What are the key findings of this study?

CTCA-derived diastolic expansion index (DE) differentiated LV diastolic function (1.79 in normal vs 1.40 in abnormal, p<0.0001), with DE <1.40 showing 88% specificity for abnormal function.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected coronary artery disease undergoing assessment for left ventricular diastolic dysfunction (n=72). Intervention: Prospectively ECG-triggered CT coronary angiography (CTCA) derived diastolic expansion (DE) index and fraction (DEF) vs. Transthoracic echocardiography (TTE) classification of LV diastolic dysfunction and invasive cardiac catheterisation. Primary outcome: Differentiation of normal from abnormal or indeterminate left ventricular diastolic function using CTCA-derived diastolic expansion (DE) index (p=<0.0001).

Q: What does this research mean for the field?

Computed tomography coronary angiography-derived diastolic expansion index differentiates left ventricular diastolic function, with an index below 1.40 providing 88% specificity for diastolic dysfunction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether computed tomography coronary angiography (CTCA) provides clinical value for evaluating left ventricular diastolic dysfunction beyond standard coronary artery imaging.

Aleksandra Lange; Harry Huntress; Jesse Steindl; Przemysław Palka

doi:10.1136/openhrt-2020-001566

March 1, 2021Open HeartOpen Access

Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function

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Key result

CTCA-derived diastolic expansion index identifies abnormal LV diastolic function with ~88% specificity.

P<0.0001
n=72

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Why the study?

It was unclear whether CT coronary angiography has clinical value for evaluating left ventricular diastolic dysfunction beyond providing traditional coronary artery anatomy.

Does prospectively ECG-triggered CT coronary angiography derived diastolic expansion index accurately differentiate left ventricular diastolic dysfunction compared to transthoracic echocardiography in patients with chest pain and preserved ejection fraction?

Key Points

To determine whether computed tomography coronary angiography (CTCA) provides clinical value for evaluating left ventricular diastolic dysfunction beyond standard coronary artery imaging.
Retrospective study of 72 consecutive patients (mean age 59±13 years) in sinus rhythm without significant valvular abnormalities who underwent both transthoracic echocardiogram (TTE) and prospectively diastole-triggered CTCA.
Calculated CTCA-derived left ventricular (LV) and left atrial (LA) volumes, diastolic expansion (DE) index (LV volume ÷ LA volume), and DE fraction (DEF) during diastasis.
Compared indices against standard TTE diastolic function classifications, with invasive cardiac catheterisation measurements obtained in a subgroup of 9 patients.
CTCA volumes were significantly larger than TTE measurements for both LV (128±35 mL vs 95±28 mL; p<0.001) and maximum LA volume (81±21 mL vs 72±25 mL; p<0.01).
A DE value >1.65 showed 85% specificity (95% CI 0.69 to 1.01) and 88% positive predictive value (95% CI 0.75 to 1.01) for diagnosing normal LV diastolic function.
A DE value <1.40 showed 88% specificity (95% CI 0.78 to 0.98) and 62% positive predictive value (95% CI 0.35 to 0.88) for diagnosing abnormal LV diastolic function.

Study Design

Type

Observational (n=72)

Blinding

Expert readers measuring CTCA LA volume were blinded to TTE results

Multicenter

No

Structured PICO

Does prospectively ECG-triggered CT coronary angiography derived diastolic expansion index accurately differentiate left ventricular diastolic dysfunction compared to transthoracic echocardiography in patients with chest pain and preserved ejection fraction?

P

Population

72 clinically stable adults (mean age 59 years, 53% female) with chest pain, low-to-moderate probability of CAD, sinus rhythm, and preserved LVEF (>=50%) undergoing both CTCA and TTE within a mean of 16 days.

E

Exposure

Prospectively ECG-triggered CT coronary angiography (CTCA) derived diastolic volume indices acquired during diastasis (standard acquisition at 78% R-R interval): LV volume, LA volume, diastolic expansion (DE) index (LV volume ÷ LA volume), and diastolic expansion fraction (DEF: [(LV volume - LA volume) ÷ LV volume] × 100).

C

Comparator

Transthoracic echocardiography (TTE) classification of LV diastolic dysfunction (normal n=42, abnormal n=20, indeterminate n=10) based on ASE/EACVI recommendations, plus invasive cardiac catheterisation LV end-diastolic pressure in a subgroup of 9 patients.

O

Outcome

Diagnostic accuracy and correlation of CTCA-derived diastolic expansion (DE) index and DE fraction (DEF) in differentiating normal from abnormal and indeterminate LV diastolic dysfunction compared to TTE reference standard.surrogate

Main Result

Absolute Event Rate: 1.79% vs 1.4%

p-value: p=<0.0001

Routine prospectively ECG-triggered CTCA can provide quantifiable information on LV diastolic dysfunction via the diastolic expansion index (LV/LA volume ratio during diastasis) without requiring full-cycle retrospective gating or additional radiation.

Limitations

Retrospective study design
Relatively long time difference between CTCA and TTE (16±24 days)
Exclusion of patients with atrial fibrillation, permanent pacemakers, significant valvular pathology, or higher heart rates resulting in a systolic scan
Small sample size and only a small subgroup of patients (n=9) underwent invasive cardiac catheterisation
Patients with atrial fibrillation, permanent pacemakers, significant valvular pathology, and higher heart rates (systolic scans) were excluded
Only a small subgroup of 9 patients underwent invasive cardiac catheterisation

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Implication

May support diastolic assessment on routine CTCA; leaves open prospective validation versus echocardiography.

Abstract

OBJECTIVE: To determine whether Computed Tomography (CT) coronary angiography (CTCA) has clinical value for the assessment of left ventricular (LV) diastolic dysfunction (DD) beyond traditional information on coronary artery anatomy. METHOD: In this retrospective study, a consecutive group of 72 patients (mean age 59±13 years)-who met the eligibility criteria of sinus rhythm, no significant valvular abnormalities, and who had transthoracic echocardiogram (TTE)-were analysed. The CTCA was prospectively triggered during diastole. Outcomes of interest were CTCA derived LV and left atrial (LA) volumes, diastolic expansion (DE) index: LV volume÷LA volume and DE fraction (DEF): [(LV volume-LA volume)÷LV volume]×100. TTE-LA volume was measured as maximum, minimum and pre-A. Studied patients were divided according to the current classification of LVDD as a reference standard. A small subgroup of nine patients underwent further invasive cardiac catheterisation. RESULTS: =0.26; p<0.0001) with the smallest differences in maximum LA volume (9±32 mL; mean±2 SD). The DE and DEF correlated with both LA function and LVDD. DE >1.65 and DE <1.40 have good specificity (85% and 88%, respectively), and positive predictive value to differentiate LVDD. DE and DEF were dependent on the patients' age but independent of other variables. CONCLUSIONS: CTCA derived diastasis volume indices can provide additional quantifiable information on LVDD.

Discussion

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Cite This Study

Lange et al. (2021) conducted an observational in Suspected coronary artery disease undergoing assessment for left ventricular diastolic dysfunction (n=72). Prospectively ECG-triggered CT coronary angiography (CTCA) derived diastolic expansion (DE) index and fraction (DEF) vs. Transthoracic echocardiography (TTE) classification of LV diastolic dysfunction and invasive cardiac catheterisation was evaluated on Differentiation of normal from abnormal or indeterminate left ventricular diastolic function using CTCA-derived diastolic expansion (DE) index (p=<0.0001). CTCA-derived diastolic expansion index (DE) differentiated LV diastolic function (1.79 in normal vs 1.40 in abnormal, p<0.0001), with DE <1.40 showing 88% specificity for abnormal function.

synapsesocial.com/papers/6a7ca5f88a7077a9e43f6f39 https://doi.org/10.1136/openhrt-2020-001566

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Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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