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Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry

  • Cardiac
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Abstract

Objectives

Late enhancement (LE) multi-slice computed tomography (leMDCT) was introduced for the visualization of (intra-) myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM). LE is associated with adverse cardiac events. This analysis focuses on leMDCT derived LV muscle mass (LV-MM) which may be related to LE resulting in LE proportion for potential risk stratification in HCM.

Methods

N=26 HCM-patients underwent leMDCT (64-slice-CT) and cardiovascular magnetic resonance (CMR). In leMDCT iodine contrast (Iopromid, 350 mg/mL; 150mL) was injected 7 minutes before imaging. Reconstructed short cardiac axis views served for planimetry. The study group was divided into three groups of varying LV-contrast. LeMDCT was correlated with CMR.

Results

The mean age was 64.2 ± 14 years. The groups of varying contrast differed in weight and body mass index (p < 0.05). In the group with good LV-contrast assessment of LV-MM resulted in 147.4 ± 64.8 g in leMDCT vs. 147.1 ± 65.9 in CMR (p > 0.05). In the group with sufficient contrast LV-MM appeared with 172 ± 30.8 g in leMDCT vs. 165.9 ± 37.8 in CMR (p > 0.05). Overall intra-/inter-observer variability of semiautomatic assessment of LV-MM showed an accuracy of 0.9 ± 8.6 g and 0.8 ± 9.2 g in leMDCT. All leMDCT-measures correlated well with CMR (r > 0.9).

Conclusions

LeMDCT primarily performed for LE-visualization in HCM allows for accurate LV-volumetry including LV-MM in > 90 % of the cases.

Key Points

• LeMDCT of relatively low contrast allows for LV planimetry in HCM.

• The correlation of leMDCT-based LV volumetry with gold-standard CMR was excellent (r > 0.9).

• LeMDCT requires approximately 2.0mL/kgBW of dye to achieve acceptable contrast.

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Abbreviations

BMI:

Body mass index

BW:

Body weight

CAD:

Coronary artery disease

CMR:

Cardiovascular magnetic resonance

CNR:

Contrast-to-noise ratio

DLP:

Dose-length product

ED:

Effective dose

HCM:

Hypertrophic cardiomyopathy

HU:

Hounsfield units

LeMDCT:

Late enhanced multi-slice computed tomography

LE:

Late enhancement

gLE:

LE mass

%LE:

LE proportion

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LV-EDV:

Left ventricular end-diastolic volume

LV-EF:

Left ventricular ejection fraction

LV-ESV:

Left ventricular end-systolic volume

LV-MM:

Left ventricular muscle mass

LV-SV:

Left ventricular stroke volume

MPR:

Multi-planar reformation

SNR:

Signal-to-noise ratio

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Acknowledgments

We wish to extend our sincere thanks to Mr. Arne Jochens for supervising our biometric analysis, to Ms. Nadin Eichhorn, SIEMENS, for "running the system" and to Ms. Kristi Hillenkamp for proofreading. The scientific guarantor of this publication is Prof. Norbert Frey. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported (Langer C, Lutz M, Eden M, et al. Hypertrophic cardiomyopathy in cardiac CT: a validation study on the detection of intramyocardial fibrosis in consecutive patients. Int J Cardiovasc Imaging 2014 Mar;30(3):659-67). Methodology: prospective, diagnostic study, multicenter study. Presentations

• American College of Cardiology Foundation Annual Meeting 2013

• European Society of Cardiology Congress 2013

• German Cardiac Society Annual Congress 2013, Fall Meeting 2013.

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Authors and Affiliations

  1. Department of Cardiology, Angiology and Critical Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Schittenhelmstr. 12, 24105, Kiel, Germany

    Christoph Langer, H. Harders, M. Lutz, M. Eden, C. Kühl & N. Frey

  2. DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany

    Christoph Langer, M. Lutz, C. Kühl & N. Frey

  3. Department of Diagnostic Radiology, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Germany

    M. Both, B. Sattler, O Jansen & P. Schaefer

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  1. Christoph Langer
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  2. M. Both
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  3. H. Harders
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  4. M. Lutz
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  5. M. Eden
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  6. C. Kühl
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  7. B. Sattler
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  8. O Jansen
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  10. N. Frey
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Corresponding author

Correspondence to Christoph Langer.

Additional information

C. Langer and M. Both contributed equally

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Langer, C., Both, M., Harders, H. et al. Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry. Eur Radiol 25, 575–584 (2015). https://doi.org/10.1007/s00330-014-3434-0

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