Korean J Radiol.  2017 ;18(4):632-642. 10.3348/kjr.2017.18.4.632.

Estimation of Diastolic Filling Pressure with Cardiac CT in Comparison with Echocardiography Using Tissue Doppler Imaging: Determination of Optimal CT Reconstruction Parameters

• Hwang JS
• Lee H
• Lee B
• Lee SJ
• Jou SS
• Lim HK
• Suh J

• KMID: 2427232
• DOI: http://doi.org/10.3348/kjr.2017.18.4.632

Abstract

OBJECTIVE
To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E"²), and E / E"².
MATERIALS AND METHODS
Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm²). E"² was calculated from the changes in the left ventricular length per cardiac phase. E / E"² was then estimated and compared with that from echocardiography.
RESULTS
For assessment of E / E"², CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E"²â‰¥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively.
CONCLUSION
Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E"² between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.

Keyword

Cardiac CT; Echocardiography; Tissue Doppler; Ventricular function; Diastolic function; Left ventricle

MeSH Terms

Adult
Aged
Aged, 80 and over
*Echocardiography, Doppler
Female
Heart Ventricles/*diagnostic imaging
Humans
Male
Middle Aged
Retrospective Studies
*Tomography, X-Ray Computed
Ventricular Function, Left

Figure

• 

  Fig. 1 Transmitral flow vs. time curves in all patients for all four datasets.Changes in left ventricle volume between two consecutive phases were calculated and plotted for each dataset reconstructed with slice thickness and increment of 0.9 mm at 5% RR-interval increments (dataset A), 0.9 mm at 10% increments (dataset B), 3 mm at 5% increments (dataset C), and 3 mm at 10% increments (dataset D).

• 

  Fig. 2 Measurement of mitral valve area and change in left ventricular (LV) length.A. Mitral valve area was manually outlined. Image reconstructed with slice thickness and increment of 0.9 mm at 65% of RR-interval (left), and 3 mm at 65% of RR-interval (right). B. Maximum change in LV length (cm) before or after phase at peak early diastolic velocity measured on four-chamber view from apex to mitral septal attachment.

• 

  Fig. 3 Comparison between echocardiography and cardiac CT for assessment of left ventricular filling pressure (E / E′).In Bland-Altman plots, solid lines represent mean differences, whereas dotted lines represent 95% limits of agreement. Note that differences are proportional to means (p < 0.05) in four absolute difference plots of two datasets. Bland-Altman plots show that cardiac CT has tendency to overestimate E / E′ as average measurements increase, and differences of E / E′ are proportional (p < 0.05) to mean in four absolute difference plots of echocardiography - CT datasets.A. Scatter plot for dataset A with slice thickness of 0.9 mm at 5% increments (left). Bland-Altman plot with regression line (right) showing mean difference (95% limits of agreement) of 0.8 ± 2.8 cm/s (−4.7 to 6.2 cm/s) and r = 0.53 (y = −0.4329x + 5.5196, p < 0.05). B. Scatter plot for dataset B with slice thickness of 0.9 mm at 10% increments (left). Bland-Altman plot with regression line (right) showing mean difference of −0.6 ± 3.8 cm/s (−8.0 to 6.7 cm/s) and r = 0.47 (y = −0.5372x + 5.5945, p < 0.05).C. Scatter plot for dataset C with slice thickness of 3 mm at 5% increments (left). Bland-Altman plot with regression line (right) showing mean difference of 1.5 ± 3.6 cm/s (−5.6 to 8.5 cm/s) and r = 0.32 (y = −0.3931x + 5.674, p < 0.05). D. Scatter plot for dataset D with slice thickness of 3 mm at 10% increments (left). Bland-Altman plot and regression line (right) showing mean difference of 0.1 ± 4.0 cm/s (−7.8 to 8.0 cm/s) and r = 0.32 (y = −0.4527x + 5.2039, p < 0.05).

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