title: Identification of Left Ventricle Failure on Pulmonary Artery CTA: Diagnostic Significance of Decreased Aortic & Left Ventricle Enhancement.
abstract: OBJECTIVE
  This study aimed to identify findings on non-ECG-gated CT pulmonary angiography (CTPA) indicating decreased left ventricle (LV) systolic function, later confirmed by echocardiogram.
  
  
  METHODS
  After obtaining institutional review board approval, review was performed of emergency department (ED) patients who had CTPA and follow-up echocardiogram within 48 h, over 18 months. Patients with pulmonary embolus, suboptimal CTPA, arrhythmias or pericardial tamponade were excluded. One hundred thirty-seven patients were identified and divided into cases (LVEF <40%, n = 52) and controls (LVEF >50%, n = 85). Two reviewers performed these analyses: measurement of enhancement in main pulmonary artery (MPA), LV, and aorta; subjective enhancement of LV and aorta (Ao) relative to MPA using a four-point Likert scale; contrast transit time (TD) to trigger CTPA and LV short & long axis dimensions. When available, the most recent N-terminal pro-B-type natriuretic peptide (NT-proBNP) level was recorded.
  
  
  RESULTS
  Decreased aortic and LV subjective enhancement were the best predictors of LV systolic dysfunction. For Ao/MPA ratio, an optimal cutoff value of 0.20 resulted in a sensitivity of 0.54 and specificity of 0.93 (AUC = 0.83, 0.78-0.88 95% CI). A threshold of 86.7 HU for Ao enhancement resulted in a sensitivity of 0.68 and specificity of 0.90 (AUC = 0.82, 0.77-0.88 95% CI). A LV short axis diameter of more than 54.3 mm had a sensitivity of 0.62 and specificity of 0.98 (AUC = 0.88, 0.83-0.92 95% CI). For the LV long axis diameter, a cutoff of 87.5 mm resulted in a sensitivity of 0.66 and specificity of 0.84 (AUC = 0.78, 0.72-0.84 95% CI). With bolus timing, cases had a longer TD (13.4 vs. 10.4 s, p < 0.0001).
  
  
  CONCLUSIONS
  Unsuspected LV systolic dysfunction can be recognized on a CTPA by identification of decreased aortic enhancement, LV enlargement and increased TD. This has important diagnostic implications for the patient presenting with shortness of breath, chest pain, or dyspnea.
authors.affiliation: Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA. toabhic@gmail.com.
authors.forename: Abhishek
authors.identifier: http://orcid.org/0000-0001-8951-3192
authors.initials: A
authors.lastname: Chaturvedi
authors.affiliation: Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Joel P
authors.initials: JP
authors.lastname: Thompson
authors.affiliation: Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kaproth-Joslin
authors.affiliation: Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Hobbs
authors.affiliation: Department Medicine: Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Karl Q
authors.initials: KQ
authors.lastname: Schwarz
authors.affiliation: Department Medicine: Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Apeksha
authors.initials: A
authors.lastname: Chaturvedi
authors.affiliation: Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Baran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D015415:Biomarkers / Q000032:analysis; D000072226:Computed Tomography Angiography; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D010446:Peptide Fragments / Q000032:analysis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Aortic enhancement; Contrast enhancement; Contrast transit time; Heart failure; Left ventricle failure; Pulmonary CT angiography