Assessment of left ventricular function and mass in patients undergoing computed tomography (CT) coronary angiography using 64-detector-row CT: comparison to magnetic resonance imaging.
OBJECTIVE
To quantify left ventricular function and mass derived from retrospectively ECG-gated 64-detector-row computed tomography coronary angiography data sets in comparison to cine magnetic resonance (MR) imaging as the reference standard. We hypothesized that the administration of beta-blockers prior to multidetector computed tomography (MDCT) coronary angiography has a significant impact on left ventricular functional parameters.


METHODS
Multiplanar reformations in the short-axis orientation were calculated from axial contrast-enhanced CT images in 21 patients (16 male, five female; age range 41-75 years, mean 64.3+/-6.8 years) referred for CT coronary angiography. Patients whose heart rates exceeded 60 bpm received 5 mg bisoprolol orally 1 hour before the MDCT examination. In case of insufficient heart-rate reduction, up to four vials (20 mg) of metoprolol were injected intravenously. The end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and left ventricular mass (LVM) of the reformatted images were analyzed compared to volumetric measurements based on continuous short-axis steady-state free-precession cine MR sequences (TR 3 ms, TE 1.5 ms, FA 60 degrees ).


RESULTS
On average, each patient received 15.5 mg metoprolol (range 0-20 mg) and 3.85 mg bisoprolol (range 0-5 mg). The mean heart rate was 56+/-5 bpm during CT and 73+/-9 bpm during MRI examination. This difference was statistically significant (P<0.05). Mean EDV and ESV measured on MDCT were significantly higher compared to MR (MDCT vs. MR: EDV 164.2+/-52.5 vs. 144.2+/-46.7 ml, ESV 77.3+/-46.6 vs. 63.8+/-47.3 ml; P<0.05). Mean EF and CO derived from MDCT images were significantly lower compared to MR (MDCT vs. MR: EF 55.4+/-11.8 vs. 59.3+/-15.4%, CO 4822+/-779 vs. 5755+/-1267 ml; P<0.05). Mean SV and LVM were not significantly different between both methods (MDCT vs. MR: SV 86.8+/-18.1 vs. 80.3+/-15.6 ml, P = 0.44; LVM 132.4+/-42.5 vs. 138.7+/-39.1 g, P = 0.31).


CONCLUSIONS
Left ventricular volumes assessed by the newest-generation MDCT scanners are significantly higher compared with MRI, whereas ejection fraction and cardiac output are significantly lower in MDCT. This appears to be a result of the frequent application of beta-blockers prior to MDCT examinations.
Schlosser
T
T
Department of Diagnostic and Interventional Radiology, University of Essen, Hufelandstrasse 55, D-45122 Essen, Germany. thomas.schlosser@uni-essen.de
Mohrs
O K
OK
Magedanz
A
A
Voigtländer
T
T
Schmermund
A
A
Barkhausen
J
J
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D017298:Bisoprolol / Q000008:administration & dosage; D002302:Cardiac Output / Q000187:drug effects; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage; D008875:Middle Aged; D009929:Organ Size / Q000187:drug effects; D012015:Reference Standards; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol; D017298:Bisoprolol