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CT Assessment of Global and Regional Cardiac Function: State of the Art

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CT Imaging of Myocardial Perfusion and Viability

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Reliable assessment of cardiac function is an important tool for diagnosis and prognosis of multiple cardiac and extracardiac diseases. Echocardiography and MRI are the most commonly used methods to evaluate cardiac function, but can be limited or contraindicated in certain patients. Functional evaluation with CT may play an important role in these patients and in those patients being evaluated for coronary artery disease. Functional imaging requires a retrospectively gated acquisition and special attention must be paid to the contrast injection technique for appropriate analysis. Left and right ventricular analysis is evaluated both quantitatively and qualitatively. Quantitative measurements with CT have shown close correlation with values obtained with CMR. Acute and chronic infarcts and non-ischemic cardiomyopathies can have a characteristic appearance on imaging. Functional and volumetric measurements of the left atrium can be carried out with similar technique for evaluation of patients with mitral disease or atrial fibrillation.

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References

  • Abecasis J, Dourado R, Ferreira A, Saraiva C (2009) Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Eurospace 11:1289–1294

    Article  Google Scholar 

  • Akram K, Anderson HD, Voros S (2009) Quantification of left ventricular parameters obtained by automated software for 64-slice multidetector computed tomography and comparison with magnetic resonance imaging. Cardiovasc Intervent Radiol 32(6):1154–1160

    Google Scholar 

  • Annuar BR, Liew CK, Chin SP, Ong TK, Seyfarth MT, Chan WL, Fong YY, Ang CK, Lin N, Liew HB, Sim KH (2008) Assessment of global and regional left ventricular function using 64-slice multislice computed tomography and 2D echocardiography: a comparison with cardiac magnetic resonance. Eur J Radiol 65(1):112–119

    Google Scholar 

  • Avelar E et al (2010) Comparison of the accuracy of multidetector computed tomography versus two-dimensional echocardiography to measure left atrial volume. Am J Cardiol 106(1):104–109

    Article  PubMed  Google Scholar 

  • Bastarrika G, Arraiza M, De Cecco CN, Mastrobuoni S, Ubilla M, Rabago G (2008) Quantification of left ventricular function and mass in heart transplant recipients using dual-source CT and MRI: initial clinical experience. Eur Radiol 18(9):1784–1790

    Article  PubMed  Google Scholar 

  • Bavelaar-Croon CD et al (2000) Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values. Radiology 217(2):572–575

    Article  PubMed  CAS  Google Scholar 

  • Belge B, Coche E, Pasquet A, Vanoverschelde JL, Gerber BL (2006) Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography: comparison with cine magnetic resonance imaging. Eur Radiol 16(7):1424–1433

    Article  PubMed  Google Scholar 

  • Braunwald E (2008) Braunwald’s heart disease: a textbook of cardiovascular medicine. In: Peter L, Robert B, Douglas M Douglas Z. Saunders (eds) Elsevier, Philadelphia

    Google Scholar 

  • Brodoefel H, Kramer U, Reimann A, Burgstahler C, Schroeder S, Kopp A, Heuschmid M (2007) Dual-source CT with improved temporal resolution in assessment of left ventricular function: a pilot study. Am J Roentgenol 189(5):1064–1070

    Google Scholar 

  • Burgess MI, Mogulkoc N, Bright-Thomas RJ, Bishop P, Egan JJ, Ray SG (2002) Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic pulmonary disease. J Am Soc Echocardiogr 15:633–639

    Article  PubMed  Google Scholar 

  • Busch S, Johnson TR, Wintersperger BJ, Minaifar N, Bhargava A, Rist C, Reiser MF, Becker C, Nikolaou K (2008) Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings. Eur Radiol 18(3):570–575

    Google Scholar 

  • Christiaens L et al (2009) A new method for measurement of LA volumes using 64-slice spiral CT: comparison with 2DE techniques. Int J Cardiol 131:217–224

    Article  PubMed  Google Scholar 

  • de Geus-Oei LF et al (2011) Scintigraphic techniques for early detection of cancer treatment-induced cardiotoxicity. J Nucl Med 52(4):560–571

    PubMed  Google Scholar 

  • de Jonge GJ et al (2011) Semi-automatic measurement of left ventricular function on dual source computed tomography using five different software tools in comparison with magnetic resonance imaging. Eur J Radiol 80(3):755–766

    Article  PubMed  Google Scholar 

  • Dell’Italia LJ, Walsh RA (1989) Effect of intravenous metoprolol on left ventricular performance in Q-wave acute myocardial infarction. Am J Cardiol 63(3):166–171

    Article  PubMed  Google Scholar 

  • Dewey M, Müller M, Teige F, Schnapauff D, Schink T, Hamm B, Lembcke A (2006) Multisegment and halfscan reconstruction of 16-slice computed tomography for assessment of regional and global left ventricular myocardial function. Invest Radiol 41(4):400–409

    Google Scholar 

  • Dupont MVM, Dragean CA, Coche EE (2011) Right ventricle function assessment by MDCT. Am J Roentgenol 196(1):77–86

    Article  Google Scholar 

  • Ferencik M et al (2007) Analysis of cardiac dimensions, mass and function in heart transplant recipients using 64-slice multi-detector computed tomography. J Heart Lung Transplant 26(5):478–484

    Article  PubMed  Google Scholar 

  • Fischbach R, Juergens KU, Ozgun M, Maintz D, Grude M, Seifarth H, Heindel W, Wichter T (2007) Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging. Eur Radiol 17(4):1009–1017

    Google Scholar 

  • Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI (2008) Fishman’s pulmonary diseases and disorders, 4th edn. McGraw Hill Medical, New York

    Google Scholar 

  • Gao Y, Du X, Liang L, Cao L, Yang Q, Li K (2012) Evaluation of right ventricular function by 64-row CT in patients with chronic obstructive pulmonary disease and cor pulmonale. Eur J Radiol 81(2):345–353

    Article  PubMed  Google Scholar 

  • Glower D Di, Lowe J Ei (2003) Left ventricular aneurysm. In: Cohn LH, Edmunds LH Jr (ed) Cardiac surgery in the adult. McGraw-Hill, New York, pp 771–788

    Google Scholar 

  • Greupner J, Zimmermann E, Hamm B, Dewey M (2011) Automatic versus semi-automatic global cardiac function assessment using 64-row computed tomography. Br J Radiol 34(5):367–374

    Google Scholar 

  • Grude M, Juergens KU, Wichter T, Paul M, Fallenberg EM, Muller JG, Heindel W, Breithardt G, Fischbach R (2003) Evaluation of global left ventricular myocardial function with electrocardiogram-gated multidetector computed tomography: comparison with magnetic resonance imaging. Invest Radiol 38(10):653–661

    Google Scholar 

  • Guo YK, Yang ZG, Ning G, Rao L, Dong L, Pen Y, Zhang TM, Wu Y, Zhang XC, Wang QL (2009) Sixty-four-slice multidetector computed tomography for preoperative evaluation of left ventricular function and mass in patients with mitral regurgitation: comparison with magnetic resonance imaging and echocardiography. Eur Radiol 19(9):2107–2116

    Google Scholar 

  • Hammermeister KE, DeRouen TA, Dodge HT (1979) Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation 59(3):421–430

    Article  PubMed  CAS  Google Scholar 

  • Hausleiter J et al (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice. Circulation 113:1305–1310

    Article  PubMed  Google Scholar 

  • Hausleiter J et al (2007) A new algorithm for ECG-based tube current modulation (MinDose) reduces radiation dose estimates in cardiac dual source CT angiography. Circulation 116:II_575

    Google Scholar 

  • Helms AS et al (2009) Relation of left atrial volume from three-dimensional computed tomography to atrial fibrillation recurrence following ablation. Am J Cardiol 103:989–993

    Article  PubMed  Google Scholar 

  • Jensen CJ, Jochims M, Hunold P, Forsting M, Barkhausen J, Sabin GV, Bruder O, Schlosser T (2010) Assessment of left ventricular function and mass in dual-source computed tomography coronary angiography: Influence of beta-blockers on left ventricular function: comparison to magnetic resonance imaging. Eur J Radiol 74(3):484–491

    Google Scholar 

  • Juergens KU, Grude M, Maintz D, Fallenberg EM, Wichter T, Heindel W, Fischbach R (2004) Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. Radiology 230(2):403–410

    Google Scholar 

  • Juergens KU, Roman F (2006) Left ventricular function studied with MDCT. Eur Radiol 16:342–357

    Google Scholar 

  • Juergens KU et al (2008) Automated threshold-based 3D segmentation versus short-axis planimetry for assessment of global left ventricular function with dual-source MDCT. Am J Roentgenology 190(2):308–314

    Article  Google Scholar 

  • Kang DK et al (2011) CT Signs of right ventricular dysfunction. JACC: Cardiovasc Imaging 4(8):841–849

    Article  Google Scholar 

  • Kircher B et al (1991) Left atrial volume determination by biplane two-dimensional echocardiography: validation by cine CT. Am Heart J 121:864–871

    Article  PubMed  CAS  Google Scholar 

  • Ko YJ, Kim SS, Park WJ, Jeong JO, Ko SM (2011) Comparison of global left ventricular function using 20 phases with 10-phase reconstructions in multidetector-row computed tomography. Int J Cardiovasc Imaging 28(3):603–611

    Article  PubMed  Google Scholar 

  • Koch K, Oellig F, Kunz P, Bender P, Oberholzer K, Mildenberger P, Hake U, Kreitner KF, Thelen M (2004) Assessment of global and regional left ventricular function with a 16-slice spiral-CT using two different software tools for quantitative functional analysis and qualitative evaluation of wall motion changes in comparison with magnetic resonance imaging. Rofo 176(12):1786–1793

    Google Scholar 

  • Lee H, Kim SY, Gebregziabher M, Hanna EL, Schoepf J (2012) Impact of ventricular contrast medium attenuation on the accuracy of left and right ventricular function analysis at cardiac multi detector-row CT compared with cardiac MRI. Acad Radiol 19:(4):395–405

    Article  PubMed  Google Scholar 

  • Lessick J, Ghersin E, Abadi S, Yalonetsky S (2008) Accuracy of the long-axis area-length method for the measurement of left ventricular volumes and ejection fraction using multidetector computed tomograph. Can J Cardiol 24(9):685–689

    Article  PubMed  Google Scholar 

  • Lin FY et al (2008) Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. JACC Cardiovasc Imaging 1(6):782–786

    Article  PubMed  Google Scholar 

  • Helena M-N, Adams KF, Willis PW (1987) Evolution of regional left ventricular wall motion abnormalities in acute Q and non-Q wave myocardial infarction. Am Heart J 113(6):1369–1375

    Google Scholar 

  • Heuschmid M, Rothfuss J, Schröder S, Küttner A, Fenchel M, Stauder N, Mahnken AH, Burgstahler C, Miller S, Claussen CD, Kopp AF (2005) Left ventricular functional parameters: comparison of 16-slice spiral CT with MRI. Rofo 177(1):60–66

    Google Scholar 

  • Maffei E, Messalli G, Martini C, Nieman K, Catalano O, Rossi A, Seitun S, Guaricci AI, Tedeschi C, Mollet NR, Cademartiri F (2012) Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR. Eur Radiol 22(5):1041–1049

    Google Scholar 

  • Mahnken AH, Spuentrup E, Niethammer M, Buecker A, Boese J, Wildberger JE, Flohr T, Sinha AM, Krombach GA, Günther RW (2003) Quantitative and qualitative assessment of left ventricular volume with ECG-gated multislice spiral CT: value of different image reconstruction algorithms in comparison to MRI. Acta Radiol 44(6):604–611

    Google Scholar 

  • Mahnken AH, Koos R, Katoh M, Spuentrup E, Busch P, Wildberger JE, Kühl HP, Günther RW (2005) Sixteen-slice spiral CT versus MR imaging for the assessment of left ventricular function in acute myocardial infarction. Eur Radiol 15(4):714–720

    Google Scholar 

  • Marcus FI et al (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia - proposed modification of the task force criteria. Circulation 121:1533–1541

    Article  PubMed  Google Scholar 

  • Mastrobuoni S et al (2011) Allograft morphology and function in heart transplant recipients surviving more than 15 years by magnetic resonance imaging and dual-source computed tomography. Eur J Cardiothorac Surg 40(1):e62–e66

    Article  PubMed  Google Scholar 

  • Melenovsky V, Borlaug B, Rosen B et al (2007) Cardiovascular features of heart failure with preserved ejection fraction versus non-failing hypertensive left ventricular hypertrophy in the urban Baltimore community. J Am Coll Cardiol 49:198–207

    Google Scholar 

  • Mo YH, Jaw FS, Wang YC, Jeng CM, Peng SF (2011) Effects of propranolol on the left ventricular volume of normal subjects during CT coronary angiography. Korean J Radiol 12(3):319

    Article  PubMed  Google Scholar 

  • Mock MB et al (1982) Survival of medically treated patients in the coronary artery surgery study (CASS) registry. Circulation 66:562–568

    Article  PubMed  CAS  Google Scholar 

  • Nevsky G, Jacobs JE, Lim RP, Donnino R, Babb JS, Srichai MB (2011) Sex-specific normalized reference values of heart and great vessel dimensions in cardiac CT angiograph. Am J Roentgenol 196:788–794

    Article  Google Scholar 

  • Plumhans C et al (2009) Comparison of manual, semi- and fully automated heart segmentation for assessing global left ventricular function in multidetector computed tomography. Invest Radiol 44(8):476–482

    Article  PubMed  Google Scholar 

  • Port S, Cobb FR, Jones RH (1980) Effects of propranolol on left ventricular function in normal men. Circulation 61(2):358–366

    Article  PubMed  CAS  Google Scholar 

  • Puesken M et al (2008) Global left-ventricular function assessment using dual-source multidetector CT: effect of improved temporal resolution on ventricular volume measurement. Eur Radiol 18(10):2087–2094

    Article  PubMed  Google Scholar 

  • Quiroz R et al (2004) Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 109(20):2401–2404

    Article  PubMed  Google Scholar 

  • Raman SV, Shah M, McCarthy B, Garcia A, Ferketich AK (2006) Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance. Am Heart J 151(3):736–744

    Google Scholar 

  • Rodevan O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H (1999) Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging 15:397–410

    Article  PubMed  CAS  Google Scholar 

  • Salm LP, Schuijf JD, de Roos A, Lamb HJ, Vliegen HW, Jukema JW, Joemai R, van der Wall EE, Bax JJ (2006) Global and regional left ventricular function assessment with 16-detector row CT: comparison with echocardiography and cardiovascular magnetic resonance. Eur J Echocardiogr 7(4):308–314

    Google Scholar 

  • Sarwar A et al (2009) Evaluating global and regional left ventricular function in patients with reperfused acute myocardial infarction by 64-slice multidetector CT: a comparison to magnetic resonance imaging. J Cardiovasc Comput Tomogr 3(3):170–177

    Article  PubMed  Google Scholar 

  • Savino G et al (2007) CT of cardiac function. J Thoracic Imaging 22(1):86–100

    Article  Google Scholar 

  • 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 Radiologica 48:30–35

    Google Scholar 

  • Seneviratne SK et al (2010) Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain: from the ROMICAT trial. Circ Cardiovasc Imaging 3(4):375–383

    Article  PubMed  Google Scholar 

  • Setser RM, Fischer SE, Lorenz CH (2000) Quantification of left ventricular function with magnetic resonance images acquired in real time. J Magn Reson Imaging 12:430–438

    Article  PubMed  CAS  Google Scholar 

  • Slart R et al (2004) Comparison of gated PET with MRI for evaluation of left ventricular function in patients with coronary artery disease. J Nucl Med 45(2):176–182

    PubMed  Google Scholar 

  • Staskiewicz G et al (2010) Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism. Eur Radiol 20:1615–1620

    Article  PubMed  Google Scholar 

  • Stojanovska J et al (2011) Reference normal absolute and indexed values from ECG-gated MDCT: left atrial volume, function, and diameter. Am J Roentgenology 197(3):631–637

    Article  Google Scholar 

  • Stollfuss JC et al (1998) Regional myocardial wall thickening and global ejection fraction in patients with low angiographic left ventricular ejection fraction assessed by visual and quantitative resting ECG-gated 99mTc-tetrofosmin single-photon emission tomography and magnetic resonance imaging. Eur J Nucl Med 25(5):522–530

    Article  PubMed  CAS  Google Scholar 

  • Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, Schmidt F, Galuschky C, Schummers G, Lang RM, Nesser HJ (2006) Quantitative assessment of left ventricular size and function: side-by-side comparison of real-time three-dimensional echocardiography and computed tomography with magnetic resonance reference. Circulation 114(7):654–661

    Google Scholar 

  • Takx RA, Moscariello A, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, Das M, Meyer M, Wildberger JE, Schoenberg SO, Fink C, Henzler T (2012) Quantification of left and right ventricular function and myocardial mass: comparison of low-radiation dose 2nd generation dual-source CT and cardiac MRI. Eur J Radiol 81(4):e598–e604

    Google Scholar 

  • Taylor DO et al (2008) Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008. J Heart Lung Transplant 27(9):943–956

    Article  PubMed  Google Scholar 

  • Taylor AJ et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. J Am Coll Cardiol 56(22):1864–1894

    Article  PubMed  Google Scholar 

  • Tsang TS et al (2006) Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 47:1018–1023

    Article  PubMed  Google Scholar 

  • van der Vleuten PA et al (2006) Quantification of global left ventricular function: comparison of multidetector computed tomography and magnetic resonance imaging. a meta-analysis and review of the current literature. Acta Radiol 47(10):1049–1057

    Article  PubMed  Google Scholar 

  • van der Vleuten PA, de Jonge GJ, Lubbers DD, Tio RA, Willems TP, Oudkerk M, Zijlstra F (2009) Evaluation of global left ventricular function assessment by dual-source computed tomography compared with MRI. Eur Radiol 19(2):271-277

    Google Scholar 

  • van Ooijen PM, de Jonge GJ, Oudkerk M (2012) Informatics in radiology: postprocessing pitfalls in using CT for automatic and semiautomatic determination of global left ventricular function. Radiographics 32(2):589–599

    Article  PubMed  Google Scholar 

  • Wen Z, Zhang Z, Yu W, Fan Z, Du J, Lv B (2010) Assessing the left atrial phasic volume and function with dual-source CT: comparison with 3T MRI. Int J Cardiovasc Imaging 26:88–92

    Article  Google Scholar 

  • Wu YW, Tadamura E, Kanao S, Yamamuro M, Okayama S, Ozasa N, Toma M, Kimura T, Kita T, Marui A, Komeda M, Togashi K (2008a) Left ventricular functional analysis using 64-slice multidetector row computed tomography: comparison with left ventriculography and cardiovascular magnetic resonance. Cardiology 109(2):135–142

    Google Scholar 

  • Wu YW, Tadamura E, Yamamuro M, Kanao S, Okayama S, Ozasa N, Toma M, Kimura T, Komeda M, Togashi K (2008b) Estimation of global and regional cardiac function using 64-slice computed tomography: a comparison study with echocardiography, gated-SPECT and cardiovascular magnetic resonance. Int J Cardiol 128(1):69–76

    Google Scholar 

  • Yamamuro M, Tadamura E, Kubo S, Toyoda H, Nishina T, Ohba M, Hosokawa R, Kimura T, Tamaki N, Komeda M, Kita T, Konishi J (2005) Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging.Radiology 234(2):381–390

    Google Scholar 

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Authors and Affiliations

  1. Cardiac MRCT Program, Massachusetts General Hospital, Boston, MA, USA

    Rishi Agrawal & Suhny Abbara

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  1. Rishi Agrawal
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  2. Suhny Abbara
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Correspondence to Suhny Abbara .

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Editors and Affiliations

  1. Center for Advanced Imaging Research (CAIR), Medical University of South Carolina Dept. Radiology, Charleston, South Carolina, USA

    U. Joseph Schoepf

  2. Ludwig-Maximilians-University Munich, Munich, Bayern, Germany

    Fabian Bamberg

  3. Department of Cardiology, Royal Liverpool and Broadgreen Universit, Liverpool, United Kingdom

    Balazs Ruzsics

  4. University Medical Center Groningen Center for Medical Imaging, Groningen, The Netherlands

    Rozemarijn Vliegenthart

  5. Sunnybrook Health Sciences Centre, Cardiothoracic Imaging Division, Department of Medical Imaging, Toronto, Ontario, Canada

    Gorka Bastarrika

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Agrawal, R., Abbara, S. (2013). CT Assessment of Global and Regional Cardiac Function: State of the Art. In: Schoepf, U., Bamberg, F., Ruzsics, B., Vliegenthart, R., Bastarrika, G. (eds) CT Imaging of Myocardial Perfusion and Viability. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_790

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