title: Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography.
abstract: BACKGROUND
  Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying.
  
  
  OBJECTIVE
  To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography.
  
  
  METHODS
  We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change.
  
  
  RESULTS
  Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD.
  
  
  CONCLUSIONS
  DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.
authors.affiliation: Cardiology Department, Haaliya Street, Haifa 31096, Israel. Electronic address: ariel.schw@gmail.com.
authors.forename: Ariel
authors.initials: A
authors.lastname: Schweitzer
authors.affiliation: Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: agmon@rambam.health.gov.il.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Agmon
authors.affiliation: Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: d_aronson@rambam.health.gov.il.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.affiliation: Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, Haifa 31096, Israel. Electronic address: s_abadi@rambam.health.gov.il.
authors.forename: Sobhi
authors.initials: S
authors.lastname: Abadi
authors.affiliation: Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: d_mutlak@rambam.health.gov.il.
authors.forename: Diab
authors.initials: D
authors.lastname: Mutlak
authors.affiliation: Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: shemy.carasso@gmail.com.
authors.forename: Shemy
authors.initials: S
authors.lastname: Carasso
authors.affiliation: Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: walkerjr@me.com.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Walker
authors.affiliation: Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: j_lessick@rambam.health.gov.il.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lessick
mesh_terms: D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology; D062185:Atrial Pressure / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002306:Cardiac Volume / Q000502:physiology; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D009200:Myocardial Contraction / Q000502:physiology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Atrial function; Atrial volume; Conduit volume; Coronary CT angiography; Heart failure; Left ventricular mass