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European Radiology

, Volume 20, Issue 7, pp 1590–1596 | Cite as

Simple area-based measurement for multidetector computed tomography to predict left ventricular size

  • Christopher L. Schlett
  • Dylan C. Kwait
  • Amir A. Mahabadi
  • Fabian Bamberg
  • Christopher J. O’Donnell
  • Caroline S. Fox
  • Udo HoffmannEmail author
Cardiac

Abstract

Objective

Measures of left ventricular (LV) mass and dimensions are independent predictors of morbidity and mortality. We determined whether an axial area-based method by computed tomography (CT) provides an accurate estimate of LV mass and volume.

Method

A total of 45 subjects (49% female, 56.0 ± 12 years) with a wide range of LV geometry underwent contrast-enhanced 64-slice CT. LV mass and volume were derived from 3D data. 2D images were analysed to determine LV area, the direct transverse cardiac diameter (dTCD) and the cardiothoracic ratio (CTR). Furthermore, feasibility was confirmed in 100 Framingham Offspring Cohort subjects.

Results

2D measures of LV area, dTCD and CTR were 47.3 ± 8 cm2, 14.7 ± 1.5 cm and 0.54 ± 0.05, respectively. 3D-derived LV volume (end-diastolic) and mass were 148.9 ± 45 cm3 and 124.2 ± 34 g, respectively. Excellent inter- and intra-observer agreement were shown for 2D LV area measurements (both intraclass correlation coefficients (ICC) = 0.99, p < 0.0001) and could be confirmed on non-contrast CT. The measured 2D LV area was highly correlated to LV volume, mass and size (r = 0.68; r = 0.73; r = 0.82; all p < 0.0001, respectively). On the other hand, CTR was not correlated to LV volume, mass, size or 2D LV area (all p > 0.27).

Conclusion

Compared with traditionally used CTR, LV size can be accurately predicted based on a simple and highly reproducible axial LV area-based measurement.

Keywords

Multidetector computed tomography Left ventricle Left ventricular size Cardio-thoracic ratio Direct transverse cardiac diameter Framingham Heart Study 

Notes

Acknowledgements

This work was supported by the National Heart, Lung and Blood Institute’s Framingham Heart Study (N01-HC-25195), National Institute of Health (NIH, R01 HL080053), and in part by Siemens Medical Solutions. Christopher Schlett was supported by grants from the German Federal Ministry of Education and Research, and Foundation of German Business, Berlin.

References

  1. 1.
    The Multicenter Postinfarction Research Group (1983) Risk stratification and survival after myocardial infarction. New Engl J Med 309:331–336Google Scholar
  2. 2.
    Kannel WB, Gordon T, Offutt D (1969) Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. Annals Intern Med 71:89–105Google Scholar
  3. 3.
    Lee TH, Hamilton MA, Stevenson LW et al (1993) Impact of left ventricular cavity size on survival in advanced heart failure. Am J Cardiol 72:672–676CrossRefPubMedGoogle Scholar
  4. 4.
    Abernethy M, Sharpe N, Smith H, Gamble G (1991) Echocardiographic prediction of left ventricular volume after myocardial infarction. J Am Coll Cardiol 17:1527–1532CrossRefPubMedGoogle Scholar
  5. 5.
    Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. New Engl J Med 322:1561–1566PubMedGoogle Scholar
  6. 6.
    White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ (1987) Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 76:44–51PubMedGoogle Scholar
  7. 7.
    Rubens M (1996) The chest x-ray in adult heart disease. In: Julian CAD, Fox KM, Hall RJC, Poole-Wilson PA (eds) Diseases of the heart. Saunders, London, pp 253–283Google Scholar
  8. 8.
    Davis JL, Murphy ML, Blue LR, Ferris EJ (1986) A comparison of objective measurements on the chest roentgenogram as screening tests for right or left ventricular hypertrophy. Am J Cardiol 58:658–660CrossRefPubMedGoogle Scholar
  9. 9.
    Cohn JN, Johnson GR, Shabetai R et al (1993) Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation 87:VI5–VI16PubMedGoogle Scholar
  10. 10.
    Giamouzis G, Sui X, Love TE, Butler J, Young JB, Ahmed A (2008) A propensity-matched study of the association of cardiothoracic ratio with morbidity and mortality in chronic heart failure. Am J Cardiol 101:343–347CrossRefPubMedGoogle Scholar
  11. 11.
    Clark AL, Coats AJ (2000) Unreliability of cardiothoracic ratio as a marker of left ventricular impairment: comparison with radionuclide ventriculography and echocardiography. Postgrad Med J 76:289–291CrossRefPubMedGoogle Scholar
  12. 12.
    Cowan NR (1959) The heart lung coefficient in older people. Br Heart J 21:238–242CrossRefPubMedGoogle Scholar
  13. 13.
    Hodges FJ, Eyster JAE (1926) Estimation of transverse cardiac diameter in man. Arch Intern Med 37:707Google Scholar
  14. 14.
    Schlosser T, Mohrs OK, Magedanz A, Voigtlander T, Schmermund A, Barkhausen J (2007) Assessment of left ventricular function and mass in patients undergoing computed tomography (CT) coronary angiography using 64-detector-row CT: comparison to magnetic resonance imaging. Acta Radiol 48:30–35CrossRefPubMedGoogle Scholar
  15. 15.
    Mao S, Takasu J, Child J, Carson S, Oudiz R, Budoff MJ (2003) Comparison of LV mass and volume measurements derived from electron beam tomography using cine imaging and angiographic imaging. Int J Cardiovasc Imaging 19:439–445CrossRefPubMedGoogle Scholar
  16. 16.
    Joemai RM, Geleijns J, Veldkamp WJ, Kroft LJ (2008) Clinical evaluation of 64-slice CT assessment of global left ventricular function using automated cardiac phase selection. Circ J 72:641–646CrossRefPubMedGoogle Scholar
  17. 17.
    Church TS, Levine BD, McGuire DK et al (2007) Coronary artery calcium score, risk factors, and incident coronary heart disease events. Atherosclerosis 190:224–231CrossRefPubMedGoogle Scholar
  18. 18.
    Greenland P, Bonow RO, Brundage BH et al (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation 115:402–426CrossRefPubMedGoogle Scholar
  19. 19.
    Hoffmann U, Bamberg F, Chae CU et al (2009) Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol 53:1642–1650CrossRefPubMedGoogle Scholar
  20. 20.
    Dawber TR, Kannel WB, Lyell LP (1963) An approach to longitudinal studies in a community: the Framingham Study. Ann New York Acad Sci 107:539–556CrossRefGoogle Scholar
  21. 21.
    Fuster V, Topol EJ, Nabel EG (2004) Atherothrombosis and coronary artery disease. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  22. 22.
    Juergens KU, Fischbach R (2006) Left ventricular function studied with MDCT. Eur Radiol 16:342–357CrossRefPubMedGoogle Scholar
  23. 23.
    Mahnken AH, Muhlenbruch G, Koos R et al (2006) Automated vs. manual assessment of left ventricular function in cardiac multidetector row computed tomography: comparison with magnetic resonance imaging. Eur Radiol 16:1416–1423CrossRefPubMedGoogle Scholar
  24. 24.
    Wiese TH, Rogalla P, Taupitz M et al (2004) Assessment of left ventricular volumes and function: intraindividual comparison of multi-slice spiral CT and electron beam CT in an animal model. Acta Radiol 45:819–827CrossRefPubMedGoogle Scholar
  25. 25.
    Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH (1991) Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 114:345–352PubMedGoogle Scholar
  26. 26.
    Woo P, Mao S, Wang S, Detrano RC (1997) Left ventricular size determined by electron beam computed tomography predicts significant coronary artery disease and events. Am J Cardiol 79:1236–1238CrossRefPubMedGoogle Scholar
  27. 27.
    Nolan J, Batin PD, Andrews R et al (1998) Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation 98:1510–1516PubMedGoogle Scholar
  28. 28.
    Lu MT, Cai T, Ersoy H et al (2009) Comparison of ECG-gated versus non-gated CT ventricular measurements in thirty patients with acute pulmonary embolism. Int J Cardiovascul Imaging 25:101–107CrossRefGoogle Scholar
  29. 29.
    Quiroz R, Kucher N, Schoepf UJ et al (2004) Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 109:2401–2404CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Christopher L. Schlett
    • 1
  • Dylan C. Kwait
    • 1
  • Amir A. Mahabadi
    • 1
  • Fabian Bamberg
    • 1
    • 2
  • Christopher J. O’Donnell
    • 3
  • Caroline S. Fox
    • 3
    • 4
  • Udo Hoffmann
    • 1
    Email author
  1. 1.Cardiac MR PET CT ProgramMassachusetts General Hospital, and Harvard Medical SchoolBostonUSA
  2. 2.Department of Clinical RadiologyUniversity Hospitals Munich, and Ludwig Maximilians UniversityMunichGermany
  3. 3.National HeartLung and Blood Institute’s Framingham Heart StudyFraminghamUSA
  4. 4.Division of Endocrinology, Metabolism, and Diabetes, Department of MedicineBrigham and Women’s Hospital, and Harvard Medical SchoolBostonUSA

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