Assessment of global left ventricular function with dual-source computed tomography in patients with valvular heart disease.
BACKGROUND
Left ventricular (LV) function is a vital parameter for prognosis, therapy guidance, and follow-up of cardiovascular disease. Dual-source computed tomography (DSCT) provides an accurate analysis of global LV function.


OBJECTIVE
To assess the performance of DSCT in the determination of global LV functional parameters in comparison with cardiovascular magnetic resonance (CMR) and two-dimensional transthoracic echocardiography (2D-TTE) in patients with valvular heart disease (VHD).


METHODS
A total of 111 patients (58 men, mean age 49.9 years) with known VHD and who underwent DSCT, 2D-TTE, and CMR a period of 2 weeks before undergoing valve surgery were included in this study. LV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), and ejection fraction (EF) were calculated by DSCT using the threshold-based technique, by 2D-TTE using a modified Simpson's method, and by CMR using Simpson's method. Agreement for parameters of LV global function was determined with the Pearson's correlation coefficient (r) and Bland-Altman analysis. All the DSCT and CMR data-sets were assessed independently by two readers.


RESULTS
Fifty of the total 111 patients had aortic VHD, 29 patients had mitral VHD, and 32 patients had mixed aortic and mitral VHD. An excellent inter-observer agreement was seen for the assessment of global LV function using DSCT (r = 0.910-0.983) and CMR (r = 0.854-0.965). An excellent or good correlation (r = 0.93, 0.95, 0.87, and 0.71, respectively, P < 0.001) was noted between the DSCT and 2D-TTE values for EDV, ESV, SV, and EF. EDV (33.7 mL, P < 0.001), ESV (12.1 mL, P < 0.001), SV (21.2 mL, P < 0.001), and EF (1.6%, P = 0.019) were significantly overestimated by DSCT when compared with 2D-TTE. An excellent correlation (r = 0.96, 0.97, 0.91, and 0.94, respectively, P < 0.001) between DSCT and CMR was seen in the evaluation of EDV, ESV, SV, and EF. EDV (15.9 mL, P < 0.001), ESV (7.3 mL, P < 0.001), and SV (8.5 mL, P < 0.001) were significantly underestimated, but EF (1.1%, P = 0.002) was significantly overestimated by DSCT when compared with CMR.


CONCLUSIONS
Our study showed that DSCT measurements of global LV function using the threshold-based technique were highly reproducible and compared more favorably with CMR measurements using Simpson's method than those of 2D-TTE using the modified Simpson's method. DSCT enables accurate quantification of global LV function in patients with VHD.
Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea.
So Hyeon
SH
Bak
Sung Min
SM
Ko
Hae Jeong
HJ
Jeon
Hyun Suk
HS
Yang
Hweung Kon
HK
Hwang
Meong Gun
MG
Song
D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007472:Iohexol / Q000031:analogs & derivatives; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left; D055815:Young Adult
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide