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Evaluation of right ventricular function by coronary computed tomography angiography using a novel automated 3D right ventricle volume segmentation approach: a validation study

  • Cardiac
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Abstract

Objectives

To evaluate right ventricle (RV) function by coronary computed tomography angiography (CTA) using a novel automated three-dimensional (3D) RV volume segmentation tool in comparison with clinical reference modalities.

Methods

Twenty-six patients with severe end-stage heart failure [left ventricle (LV) ejection fraction (EF) <35%] referred to CTA were enrolled. A specific individually tailored biphasic contrast agent injection protocol was designed (80%/20% high/low flow) was designed. Measurement of RV function [EF, end-diastolic volume (EDV), end-systolic volume (ESV)] by CTA was compared with tricuspid annular plane systolic excursion (TAPSE) by transthoracic echocardiography (TTE) and right heart invasive catheterisation (IC).

Results

Automated 3D RV volume segmentation was successful in 26 (100%) patients. Read-out time was 3 min 33 s (range, 1 min 50s–4 min 33s). RV EF by CTA was stronger correlated with right atrial pressure (RAP) by IC (r = -0.595; p = 0.006) but weaker with TAPSE (r = 0.366, p = 0.94). When comparing TAPSE with RAP by IC (r = -0.317, p = 0.231), a weak-to-moderate non-significant inverse correlation was found. Interobserver correlation was high with r = 0.96 (p < 0.001), r = 0.86 (p < 0.001) and r = 0.72 (p = 0.001) for RV EDV, ESV and EF, respectively. CT attenuation of the right atrium (RA) and right ventricle (RV) was 196.9 ± 75.3 and 217.5 ± 76.1 HU, respectively.

Conclusions

Measurement of RV function by CTA using a novel 3D volumetric segmentation tool is fast and reliable by applying a dedicated biphasic injection protocol. The RV EF from CTA is a closer surrogate of RAP than TAPSE by TTE.

Key Points

• Evaluation of RV function by cardiac CTA by using a novel 3D volume segmentation tool is fast and reliable.

• A biphasic contrast agent injection protocol ensures homogenous RV contrast attenuation.

• Cardiac CT is a valuable alternative modality to CMR for the evaluation of RV function.

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Abbreviations

ARVD:

Arrhythmogenic right ventricular dysfunction

CMP:

Cardiomyopathy

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

LV:

Left ventricle

PASP:

Pulmonary artery systolic pressure

RAP:

Right atrial pressure

rIC:

Right heart invasive catheterisation

RA:

Right atrium

RV:

Right ventricle

TAPSE:

Tricuspid annular plane systolic excursion

TTE:

Transthoracic echocardiogram

TR:

Tricuspid regurgitation

VAD:

Ventricular assist device

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Philipp Burghard, Christoph Beyer, Andrea Klauser, Stefan Rauch, Christian-Ekkehardt Langer & Gudrun Feuchtner

  2. Breitenwangerstrasse 19, 6600, Reutte, Austria

    Philipp Burghard

  3. Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Fabian Plank, Silvana Müller, Jakob Dörler, Marc-Michael Zaruba, Leo Pölzl, Gerhard Pölzl, Fabian Barbieri & Wilfried Schgoer

  4. Department of Radiology, Mayo Clinic Rochester, Minnesota, 200 1st St SW, Rochester, MN, 55902, USA

    Eric E. Williamson

Authors
  1. Philipp Burghard
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  2. Fabian Plank
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  3. Christoph Beyer
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  4. Silvana Müller
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  10. Stefan Rauch
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  12. Christian-Ekkehardt Langer
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  14. Eric E. Williamson
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  15. Gudrun Feuchtner
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Corresponding author

Correspondence to Philipp Burghard.

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Guarantor

The scientific guarantor of this publication is Ao.Univ.-Prof. Dr. Gudrun Feuchtner.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Gudrun M. Feuchtner—research collaboration with Siemens, SyngoVIA; no financial, no grant.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was not required because of specific regulations for retrospective studies in Innsbruck, Austria.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Burghard, P., Plank, F., Beyer, C. et al. Evaluation of right ventricular function by coronary computed tomography angiography using a novel automated 3D right ventricle volume segmentation approach: a validation study. Eur Radiol 28, 5129–5136 (2018). https://doi.org/10.1007/s00330-018-5523-y

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  • DOI: https://doi.org/10.1007/s00330-018-5523-y

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