title: Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain.
abstract: OBJECTIVE
  To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures.
  
  
  METHODS
  This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis.
  
  
  RESULTS
  225 subjects (age, 56.2±11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01-1.13permm) and LV mass (HR:1.05, 95%CI:1.00-1.10perg) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE.
  
  
  CONCLUSIONS
  CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and obstructive coronary artery disease.
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Richard A P
authors.initials: RAP
authors.lastname: Takx
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; University of Groningen/University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Department of Radiology, Groningen, The Netherlands.
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: John W
authors.initials: JW
authors.lastname: Nance
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abro
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Carr
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Apfaltrer
mesh_terms: D059787:Acute Pain / Q000000981:diagnostic imaging / Q000473:pathology; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000473:pathology; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000473:pathology; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Cardiovascular events; Computed tomography; Left atrial size; Left ventricular function