Key result
Higher myocardial hypodensity on CCTA is linked to worse LAEF and progressive diastolic dysfunction.
Why the study?
To investigate the association between myocardial hypodensity on standard CCTA and echocardiographic diastolic dysfunction grade, and to evaluate correlations with CT-derived LA and LV functional parameters.
Does quantitative myocardial hypodensity on CCTA correlate with echocardiographic diastolic dysfunction and left atrial functional impairment in patients with suspected coronary artery disease?
Observational (n=156)
No
Does quantitative myocardial hypodensity on CCTA correlate with echocardiographic diastolic dysfunction and left atrial functional impairment in patients with suspected coronary artery disease?
Effect estimate: ρ = -0.41
p-value: p=<0.001
Quantitative myocardial hypodensity on routine CCTA correlates with echocardiographic diastolic dysfunction and left atrial functional impairment, suggesting its potential utility as an early marker of diastolic burden.
Purpose To investigate the association between myocardial hypodensity on standard coronary computed tomography angiography (CCTA) and echocardiographic diastolic dysfunction (DD) grade, and to evaluate correlations between hypodensity percentage and CT-derived left atrium (LA) and left ventricular (LV) functional parameters. Material and methods This retrospective study included 156 patients (mean age 47.9 ± 11.4 years, 86 men) who underwent CCTA for suspected coronary artery disease and had comprehensive echocardiographic data. Myocardial hypodensity was quantified as the percentage of LV myocardium with attenuation < 46 HU using semi-automated, patient-specific attenuation mapping. Left atrial ejection fraction (LAEF) and volumes were derived from multiphase CCTA reconstructions, and echocardiographic diastolic dysfunction was classified as per American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) 2016 guidelines. Coronary artery disease (CAD) severity (CAD-RADS 2.0) and cardiovascular risk (SMART score) were also recorded. Correlation, ROC, and multivariate regression analyses were performed; a data-driven LAEF threshold was used to stratify impaired atrial function. Results Hypodensity percentage correlated inversely with LAEF (ρ = –0.41, p < 0.001) and left ventricle ejection fraction (LVEF) (ρ = –0.29, p = 0.006), and positively with LA volume (ρ = 0.34, p = 0.002). ROC analysis showed that a hypodensity threshold of 9.5% predicted reduced LAEF (< 47%) with 36% sensitivity and 71% specificity (AUC = 0.67, ρ < 0.05). Hypodensity increased across DD grades: 5.7% (grade 1), 12.6% (grade 2), and 24.8% (grade 3), ρ < 0.001. Conclusions Quantitative myocardial hypodensity on CCTA correlates with subclinical diastolic dysfunction and LA functional impairment. These findings support the potential of incorporating perfusion metrics into routine CCTA workflows to improve early diastolic assessment.
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Bulut et al. (2026) conducted an observational in Suspected coronary artery disease (n=156). Myocardial hypodensity on CCTA vs. Normal myocardial density was evaluated on Correlation between myocardial hypodensity percentage and left atrial ejection fraction (LAEF) (ρ = -0.41, p=<0.001). Myocardial hypodensity percentage on CCTA correlated inversely with left atrial ejection fraction (ρ = -0.41, p < 0.001) and increased progressively across diastolic dysfunction grades.
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