title: Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices.
abstract: BACKGROUND
  Right ventricular (RV) failure is a major contributor to morbidity and mortality after left ventricular assist device (LVAD) implantation. Accurate evaluation of RV function in patients with LVAD remains challenging. We hypothesized that, after LVAD implantation, electrocardiographic-gated cardiac computed tomography (CCT) allows RV evaluation with higher feasibility and reproducibility compared with echocardiography.
  
  
  METHODS
  Thirty-six patients with an implanted LVAD who had 2-dimensional echocardiography and CCT evaluation were studied. RV end-diastolic and end-systolic volumes and ejection fraction were quantified using CCT. RV fractional area change, tricuspid annular plane systolic excursion and RV end-diastolic short-to-long axis ratio were calculated by echocardiography. Intraclass correlation coefficients (ICCs) and Bland-Altman analysis were used to assess intra- and interobserver reproducibility for all measurements.
  
  
  RESULTS
  The quality of CCT studies was good in all cases except for one. Intra- and interobserver reproducibility for all CCT measurements was high (interobserver ICC for RV ejection fraction = 0.89, 95% confidence interval 0.74 to 0.95). Echocardiographic indices of RV function and geometry had lower reproducibility. The echocardiographic index that best correlated with the CCT-determined RV ejection fraction was RV fractional area change (r = 0.80, p < 0.001). In addition, CCT detected relevant post-operative findings in 50% of the patients.
  
  
  CONCLUSIONS
  CCT is highly effective and reproducible compared with echocardiography for the evaluation of RV function in patients with LVAD support and provides relevant information on post-operative findings. Our results suggest that CCT should be considered as a useful imaging modality in this clinical setting.
authors.affiliation: Zena and Michael A Wiener Cardiovascular Institute and Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia-Alvarez
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernandez-Friera
authors.forename: Joe F
authors.initials: JF
authors.lastname: Lau
authors.forename: Simonette T
authors.initials: ST
authors.lastname: Sawit
authors.forename: Jesus G
authors.initials: JG
authors.lastname: Mirelis
authors.forename: Javier G
authors.initials: JG
authors.lastname: Castillo
authors.forename: Sean
authors.initials: S
authors.lastname: Pinney
authors.forename: Anelechi C
authors.initials: AC
authors.lastname: Anyanwu
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011184:Postoperative Period; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology