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Identification of Left Ventricle Failure on Pulmonary Artery CTA: Diagnostic Significance of Decreased Aortic & Left Ventricle Enhancement

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Abstract

Purpose

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).

Conclusion

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.

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Abbreviations

AB:

Abhishek Chaturvedi

TB:

Timothy Baran

JT:

Joel Thompson

KKJ:

Katherine Kaproth-Joslin

SKH:

Susan K Hobbs

AP:

Apeksha Chaturvedi

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Author information

Authors and Affiliations

  1. Department of Imaging Science, University of Rochester Medical Center, Rochester, NY, USA

    Abhishek Chaturvedi, Joel P. Thompson, Katherine Kaproth-Joslin, Susan K. Hobbs, Apeksha Chaturvedi & Timothy Baran

  2. Department Medicine: Cardiology, University of Rochester Medical Center, Rochester, NY, USA

    Karl Q. Schwarz & Vijay K Krishnamoorthy

Authors
  1. Abhishek Chaturvedi
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  2. Joel P. Thompson
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  3. Katherine Kaproth-Joslin
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  4. Susan K. Hobbs
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  5. Karl Q. Schwarz
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  6. Vijay K Krishnamoorthy
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  7. Apeksha Chaturvedi
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  8. Timothy Baran
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Corresponding author

Correspondence to Abhishek Chaturvedi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent from individuals was waived by the IRB in this retrospective study.

Electronic supplementary material

Supplementary Figure 1a

Box plots, separated by Ao subjective score, showing differences in LV diameters (TIFF 56 kb)

High Resolution Image (GIF 12 kb)

Supplementary Figure 1b

contrast enhancement (TIFF 70 kb)

High Resolution Image (GIF 15 kb)

Supplementary Figure 1c

contrast enhancement ratios (TIFF 51 kb)

High Resolution Image (GIF 11 kb)

Supplementary Figure 1d

bolus triggering time (TIFF 56 kb)

High Resolution Image (GIF 19 kb)

Supplementary Figure 1e

BNP. Center lines correspond to median values, boxes span from the first to third quartiles, and whiskers represent minimum and maximum values. (TIFF 55 kb)

High Resolution Image (GIF 17 kb)

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Chaturvedi, A., Thompson, J.P., Kaproth-Joslin, K. et al. Identification of Left Ventricle Failure on Pulmonary Artery CTA: Diagnostic Significance of Decreased Aortic & Left Ventricle Enhancement. Emerg Radiol 24, 487–496 (2017). https://doi.org/10.1007/s10140-017-1494-6

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  • DOI: https://doi.org/10.1007/s10140-017-1494-6

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