Journal of Cardiovascular Computed Tomography
Review ArticleUse of multidetector computed tomography for evaluation of global and regional left ventricular function
Introduction
Left ventricular (LV) function was shown to play a paramount role in the evaluation, management, and prognosis of patients with coronary artery disease,1, 2 myocardial infarction,3 coronary bypass surgery,4, 5 LV dysfunction,6 malignant ventricular arrhythmias,7, 8, 9 and chronic valvular regurgitation.10, 11 Accurate assessment of LV function is therefore indispensable to every clinical cardiology practice. Development of a comprehensive noninvasive imaging tool for that purpose has been the “holy grail” of cardiac imaging. Such a method has to combine accuracy with reproducibility, wide availability, broad applicability, as well as cost and time effectiveness.
Section snippets
Overview of imaging methods used for cardiac function assessment
Several imaging methods were introduced for assessment of LV function; however, no single technique is yet able to provide a comprehensive assessment (Table 1). Although 2-dimensional echocardiography (2D echo) is widely available, portable, easily performed, relatively cheap and lacks major contraindications, it remains largely operator and acoustic window dependent, resulting in relatively low reproducibility and inherently limited diagnostic accuracy.12, 13, 14 In addition, 2D echo relies
Assessment of LV function with MDCT
With the advent of multidetector CT (MDCT), a novel tool for assessing cardiac function became available. The fact that 4-dimension functional information is inherently available in each acquired data set during helical coronary CT angiography at no extra cost to the patient in terms of radiation exposure or contrast material delivery makes retrospectively ECG-gated cardiac CT highly advantageous for determining ventricular function. Several studies have investigated the potential of MDCT as a
Accuracy and reproducibility of MDCT for assessment of LV function
With the use of 2D- or 3D-based segmentation, global systolic LV function variables such as LV SV and LV EF can be easily derived from volumes calculated at the end-diastolic and-end systolic phases. If LV volume is additionally computed from serially reconstructed phases with sufficient temporal resolution, a time–volume curve can be generated so that more time-dependent systolic and diastolic LV function variables, such as PER, PFR, time to PER, and time to PFR, can be assessed. Qualitative
Temporal resolution
Because of limited temporal resolution, systematic errors and motion artifacts adversely affect cardiac MDCT imaging, especially in patients with fast or irregular heart rates. In addition, assessment of myocardial wall motion continues to pose a real challenge even for today's faster, more advanced systems. Unlike coronary CT angiography, most experts do not recommend the use of β-blocking agents during functional imaging because of their potential hemodynamic effects that might confound
Conclusion
To date, no single noninvasive imaging method has shown a clear superiority for the simultaneous comprehensive evaluation of coronary anatomy and LV function. It was not until the introduction of MDCT scanning techniques in the early 1990s that CT could attain sufficient spatial and temporal resolution to allow functional imaging of the heart. Advantages of MDCT over competing methods include an outstanding spatial resolution, independence of geometric assumptions, application of direct
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Conflict of interest: The authors report no conflicts of interest.