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Determination of cardiac output with dynamic contrast-enhanced computed tomography

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Abstract

Cardiac output (CO) is an important diagnostic and prognostic factor in the haemodynamic evaluation of patients. The gold standard for CO measurement, thermodilution, requires an invasive right-heart catheterisation (RHC). In this pilot study we aimed to determine the accuracy of non-invasive CO determination from dynamic contrast-enhanced computed tomography (CT) compared to thermodilution. Patients who underwent diagnostic or follow-up RHC due to suspected or known pulmonary vascular disease at our department and required a thoracic CT between June 2011 and August 2012 were included. CO was determined from CT attenuation-time curves in the pulmonary artery and the ascending aorta using a dynamic contrast-enhanced CT sequence. CO determined in N = 18 patients by dynamic CT in the pulmonary artery was in very good agreement with thermodilution data (r = 0.84). Bland–Altman analysis showed a systematic overestimation of 0.7 ± 0.6 l/min compared to thermodilution. Data from the ascending aorta also showed a good correlation, but with a larger scattering of the values. The average effective dose for the dynamic investigation was 1.2 ± 0.7 mSv. CO determined with dynamic contrast-enhanced CT in the main pulmonary artery reliably predicts the values obtained by thermodilution during RHC. This non-invasive technique might provide an alternative for repeated invasive right-heart catheter investigations in the follow-up of pulmonary arterial hypertension patients.

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Acknowledgments

The authors would like to thank Wolfgang Loidl for his help in setting up the examination protocol and Dr. László Fóris for his comments on the manuscript. This study was financed by the Ludwig Boltzmann Institute for Lung Vascular Research. This study is registered at ClinicalTrials.gov under the identifier NCT01607489.

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Authors and Affiliations

  1. Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010, Graz, Austria

    Michael Pienn, Gabor Kovacs, Maria Tscherner, Andrea Olschewski, Horst Olschewski & Zoltán Bálint

  2. Division of Pulmonology, Department of Internal Medicine, Medical University Graz, Graz, Austria

    Gabor Kovacs, Maria Tscherner & Horst Olschewski

  3. Institute for Clinical Radiology, Ludwig Maximilians University, Munich, Germany

    Thorsten R. Johnson

  4. DiagnostikZentrum Graz, Graz, Austria

    Peter Kullnig

  5. Institute for Medical Engineering, Graz University of Technology, Graz, Austria

    Rudolf Stollberger

  6. Experimental Anesthesiology, Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Graz, Austria

    Andrea Olschewski

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  1. Michael Pienn
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  2. Gabor Kovacs
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Correspondence to Zoltán Bálint.

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Pienn, M., Kovacs, G., Tscherner, M. et al. Determination of cardiac output with dynamic contrast-enhanced computed tomography. Int J Cardiovasc Imaging 29, 1871–1878 (2013). https://doi.org/10.1007/s10554-013-0279-6

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  • DOI: https://doi.org/10.1007/s10554-013-0279-6

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