Review Article
Use of multidetector computed tomography for evaluation of global and regional left ventricular function

https://doi.org/10.1016/j.jcct.2008.10.016Get rights and content

Abstract

Left ventricular (LV) function was shown to play a paramount role in the evaluation, management, and prognosis of patients with cardiac pathology. With the advent of multidetector computed tomography (MDCT), a novel tool for cardiac function assessment became available. This comes at no additional cost to the patient undergoing coronary CT angiography in terms of radiation exposure or contrast material delivery. The accuracy of LV function assessment by retrospective electrocardiographic gating intimately depends on the level of spatial and temporal resolution achievable during scanning. With the aid of today's fast-advancing technology, MDCT is now capable of acquiring data with isotropic submillimeter voxels that allow true 3-dimensional threshold-based chamber segmentation for accurate volumetric analysis. The challenge, however, continues to involve optimizing temporal resolution through various reconstruction techniques and technologic innovations. MDCT-determined global LV function variables were shown to strongly correlate with those of standard imaging methods. Regional function assessment has now become feasible with today's latest scanners. Its accuracy, however, still awaits a major breakthrough in temporal resolution to approach or possibly surpass that of echocardiography or magnetic resonance imaging.

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

References (96)

  • J.J. Bax et al.

    Comparison of gated single-photon emission computed tomography with magnetic resonance imaging for evaluation of left ventricular function in ischemic cardiomyopathy

    Am J Cardiol

    (2000)
  • J.P. Ioannidis et al.

    Electrocardiogram-gated single-photon emission computed tomography versus cardiac magnetic resonance imaging for the assessment of left ventricular volumes and ejection fraction: a meta-analysis

    J Am Coll Cardiol

    (2002)
  • I.Y. Hyun et al.

    Reproducibility of Tl-201 and Tc-99m sestamibi gated myocardial perfusion SPECT measurement of myocardial function

    J Nucl Cardiol

    (2001)
  • E.G. DePuey et al.

    Comparison of Tc-99m sestamibi and Tl-201 gated perfusion SPECT

    J Nucl Cardiol

    (1999)
  • F. Grothues et al.

    Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy

    Am J Cardiol

    (2002)
  • D.B. Longmore et al.

    Dimensional accuracy of magnetic resonance in studies of the heart

    Lancet

    (1985)
  • M. Habis et al.

    Acute myocardial infarction early viability assessment by 64-slice computed tomography immediately after coronary angiography: comparison with low-dose dobutamine echocardiography

    J Am Coll Cardiol

    (2007)
  • N. Funabashi et al.

    Retrospective ECG-gated left ventriculography using multislice CT following left ventricular bolus injection and evaluation of its utility and motion artifact at every cardiac phase

    Int J Cardiol

    (2006)
  • J.D. Schuijf et al.

    Assessment of left ventricular volumes and ejection fraction with 16-slice multi-slice computed tomography; comparison with 2D-echocardiography

    Int J Cardiol

    (2007)
  • M. Dewey et al.

    Evaluation of global and regional left ventricular function with 16-slice computed tomography, biplane cineventriculography, and two-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging

    J Am Coll Cardiol

    (2006)
  • M. Gilard et al.

    Multi-slice computer tomography of left ventricular function with automated analysis software in comparison with conventional ventriculography

    Eur J Radiol

    (2006)
  • J. Butler et al.

    Comparison of multidetector computed tomography and two-dimensional transthoracic echocardiography for left ventricular assessment in patients with heart failure

    Am J Cardiol

    (2007)
  • J. Lessick et al.

    Comparison of multidetector computed tomography versus echocardiography for assessing regional left ventricular function

    Am J Cardiol

    (2005)
  • M.M. Henneman et al.

    Assessment of global and regional left ventricular function and volumes with 64-slice MSCT: a comparison with 2D echocardiography

    J Nucl Cardiol

    (2006)
  • M.S. Dirksen et al.

    Usefulness of dynamic multislice computed tomography of left ventricular function in unstable angina pectoris and comparison with echocardiography

    Am J Cardiol

    (2002)
  • S.V. Raman et al.

    Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance

    Am Heart J

    (2006)
  • B.R. Annuar et al.

    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

    (2008)
  • M. Emond et al.

    Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) Registry

    Circulation

    (1994)
  • K.E. Hammermeister et al.

    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

    (1979)
  • H.D. White et al.

    Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction

    Circulation

    (1987)
  • B.J. Feild et al.

    Left ventricular function and hypertrophy in cardiomyopathy with depressed ejection fraction

    Circulation

    (1973)
  • J.T. Bigger et al.

    The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction

    Circulation

    (1984)
  • A.J. Moss et al.

    Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators

    N Engl J Med

    (1996)
  • A.J. Moss et al.

    Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction

    N Engl J Med

    (2002)
  • R.I. Tafreshi et al.

    Predictors of left ventricular performance after valve replacement in children and adolescents with chronic aortic regurgitation

    Pediatr Cardiol

    (2005)
  • G. Kronik et al.

    Comparative value of eight M-mode echocardiographic formulas for determining left ventricular stroke volume. A correlative study with thermodilution and left ventricular single-plane cineangiography

    Circulation

    (1979)
  • N.B. Schiller et al.

    Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms

    J Am Soc Echocardiogr

    (1989)
  • L.P. Badano et al.

    Real-time three-dimensional echocardiography: technological gadget or clinical tool?

    J Cardiovasc Med (Hagerstown)

    (2007)
  • Y. Bernard et al.

    Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients

    Echocardiography

    (2001)
  • F.H. Sheehan et al.

    Variability in the measurement of regional left ventricular wall motion from contrast angiograms

    Circulation

    (1983)
  • N.L. Choragudi et al.

    Comparison of echocardiography with technetium 99m-gated single photon emission computed tomography as diagnostic tools for left ventricular ejection fraction

    Echocardiography

    (2001)
  • G. Germano et al.

    Automatic quantification of ejection fraction from gated myocardial perfusion SPECT

    J Nucl Med

    (1995)
  • D.P. Lum et al.

    Comparison of automatic quantification software for the measurement of ventricular volume and ejection fraction in gated myocardial perfusion SPECT

    Nucl Med Commun

    (2003)
  • H. Sakuma et al.

    Improved reproducibility in measuring LV volumes and mass using multicoil breath-hold cine MR imaging

    J Magn Reson Imaging

    (1996)
  • R.J. van der Geest et al.

    Quantification of global and regional ventricular function in cardiac magnetic resonance imaging

    Top Magn Reson Imaging

    (2000)
  • H.P. Kuhl et al.

    Assessment of myocardial function with interactive non-breath-hold real-time MR imaging: comparison with echocardiography and breath-hold Cine MR imaging

    Radiology

    (2004)
  • Y. Koyama et al.

    Assessment of reperfused acute myocardial infarction with two-phase contrast-enhanced helical CT: prediction of left ventricular function and wall thickness

    Radiology

    (2005)
  • J. Horiguchi et al.

    Quantification of coronary artery calcium using multidetector CT and a retrospective ECG-gating reconstruction algorithm

    AJR Am J Roentgenol

    (2001)
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    Conflict of interest: The authors report no conflicts of interest.

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