title: Clinical and prognostic correlates of pulmonary congestion in coronary computed tomography angiography data sets.
abstract: BACKGROUND
  Signs of pulmonary congestion obtained from cardiac computed tomography angiographic (coronary CTA) images have not previously been related to clinical congestion or outcome and the clinical value is, therefore, unknown. Our objective was to test the hypothesis that signs of pulmonary congestion predict clinical heart failure and adverse outcome in patients with myocardial infarction.
  
  
  METHODS
  Coronary CTA was performed before invasive treatment in 400 prospectively included patients with non ST segment elevation myocardial infarction in an observational study. Using a previously described chest computed tomography evaluation algorithm, patients were classified as having "no congestion", "mild to moderate congestion" or "severe congestion".
  
  
  RESULTS
  Using multivariate analyses, presence of pulmonary congestion on coronary CTA images was associated with age, female gender, left ventricular ejection fraction (LVEF) and left atrial size. The diagnostic accuracy for predicting clinical heart failure, defined as Killip class >1, was: sensitivity: 83%, specificity: 69%, positive predictive value: 25%, and negative predictive value: 97%. The median follow-up time was 50 months and the study end-point of death or hospitalization due to heart failure was reached in 68 (16%) patients. In a Cox proportional hazards model with adjustments for known risk factors and Killip class, the presence of "mild to moderate congestion" and "severe congestion" was independently associated with adverse outcome (Hazard ratio: 2.6 (95% CI:1.3-5.0) and 3.2 (1.3-7.5)).
  
  
  CONCLUSIONS
  Signs of pulmonary congestion on coronary CTA images are closely correlated to cardiac dysfunction, predict clinical heart failure, and provide prognostic value independent of LVEF and Killip class.
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: Tobiaskh@gmail.com.
authors.forename: J Tobias
authors.initials: JT
authors.lastname: Kühl
authors.affiliation: Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Kristensen
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Anna F
authors.initials: AF
authors.lastname: Thomsen
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Hindsø
authors.affiliation: Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Kristoffer L
authors.initials: KL
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Olav W
authors.initials: OW
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark; Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: Cardiac computed tomography; Cardiac computed tomography angiography; Heart failure; Myocardial infarction; Pulmonary edema