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Kang, Hong, Park, and Lee: Reliability in Using Routine Coronary CT Angiography with Retrospective Electrocardiographic Gating for the Comprehensive Functional Evaluation of the Left Ventricle
Original Article

J Korean Soc Radiol 2019;80(1):69-80.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.1.69

Reliability in Using Routine Coronary CT Angiography with Retrospective Electrocardiographic Gating for the Comprehensive Functional Evaluation of the Left Ventricle

Eun-Ju Kang, MD1, Jihoon Hong, MD2, Jongmin Park, MD2, Jongmin Lee, MD2, ∗

1Department of Radiology, Dong-A University Hospital, Busan, Korea

2Department of Radiology, Kyungpook National University Hospital, Daegu, Korea

∗Corresponding author Jongmin Lee, MD Department of Radiology, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu 41944, Korea. Tel 82-53-420-5399 Fax 82-53-422-2677 E-mail jonglee@knu.ac.kr

Received 28 May 2018       Revised 4 July 2018       Accepted 2 August 2018

Copyright © 2019 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the feasibility of comprehensive left ventricle (LV) functional parameters on routine coronary computed tomographic angiography (CCTA) based on two-dimensional echocardiography (2DE).

Materials and Methods

Ninety-nine patients who underwent CCTA accompanied by 2DE were included in the study. The volumetric LV systolic functional parameters were acquired from 10-phase reconstruction of CCTA data. By differentiating the time-LV volume curve by time domain and measuring mitral valvular orifice areas, transmitral time-velocity curves were drawn and the early (E) to late (A) mitral inflow peak velocities ratio (E/A ratio) was acquired. By measuring a longitudinal jerking velocity of the mitral valvular annulus on a four-chamber view, the mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (E') ratio (E/E' ratio) was evaluated. All functional parameters were compared with the 2DE results.

Results

The LV end diastolic volume, LV end systolic volume, ejection fraction, stroke volume, cardiac output, and LV myocardial mass measured by CCTA and 2DE showed moderate to strong correlations (r = 0.732, 0.821, 0.416, 0.394, 0.328, and 0.764, respectively;p < 0.05). The E/A and E/E' ratios showed strong correlation between CCTA and echocardiography (r = 0.807 and 0.751, respectively;p < 0.05).

Conclusion

When CCTA is performed with retrospective electrocardiographic gating, additional information about the LV function can be acquired as reliably as with echocardiography.

References

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Fig. 1.
The systolic functional analysis of the LV with CCTA. From CCTA with retrospective ECG gating, the LV volume is plotted along 10 phases during one cardiac cycle. Based on the LV time-volume curve (upper graph), LV volume differences between neighboring image sets were measured. Inter-phase time interval was calculated from simultaneously recorded heart rate. Subsequently, transmitral unit flow (mL/s, lower graph) was measured as inter-phase LV volume difference divided by time interval. A = peak trans-mitral velocity in late diastole, CCTA = coronary computed tomographic angiography, E = peak transmitral velocity in early diastole, ECG = electrocardiography, EDV = end diastolic volume, ESV = end systolic volume, LV = left ventricle
jksr-80-69f1.tif
Fig. 2.
The diastolic functional analysis of the LV with coronary computed tomography angiography. A. Mitral valvular orifice area is measured on the mitral valvular ‘en face' plane (dotted line) at distal end level of valvular leaflets on neighboring phase images. The LV axis for ‘en face' plane of mitral valve was positioned perpendicular to mid-mitral valve annulus on both 4-chamber view and 2-chamber view plans. Transmitral flow velocity at each cardiac phase can be measured from inter-phase LV volume change divided by mitral valvular orifice area. Early filling velocity (E) and atrial filling velocity (A) can be depicted atmid-systolic and end-diastolic phases. B. The longitudinal LV lengths (arrows) are measured for each phase between the annular attachment site of septal mitral valve leaflet and cardiac apex. For each phase, mitral septal annular velocity was computed using traveling distance of mitral septal annulus and heart rate. Finally, the early-diastolic mitral valvular annular tissue velocity (E') can be calculated. LV = left ventricle
jksr-80-69f2.tif
Fig. 3.
Comparisons of CCTA and 2DE for LV end diastolic volumes (A, B) and end-systolic volumes (C, D). Scatter plots (A, C) show the correlations between the both techniques. Bland-Altman plots (B, D) showing the difference (vertical axis) and average (horizontal axis) of the measurements in two techniques. 2DE = two-dimensional Doppler echocardiography, CCTA = coronary computed tomography angiography, cLVEDV = LV end-diastolic volume on CCTA, cLVESV = LV end-systolic volume on CCTA, CT = computed tomography, eLVEDV = LV end-diastolic volume on 2DE, eLVESV = LV end-systolic volume on 2DE, LV = left ventricle, SD = standard deviation
jksr-80-69f3.tif
Fig. 4.
Comparisons of CCTA and 2DE for E/A (A, B) and E/E' (C, D). Scatter plots (A, C) show the correlations between the both techniques. Bland-Altman plots (B, D) showing the difference (vertical axis) and average (horizontal axis) of the measurements in two techniques. 2DE = two-dimensional Doppler echocardiography, CCTA = coronary computed tomography angiography, cEA = E/A on CCTA, cEE = E/E' on CCTA, CT = computed tomography, eEA = E/A on 2DE, eEE = E/E' on 2DE, SD = standard deviation
jksr-80-69f4.tif
Table 1.
Comparison of the Functional Parameters of the LV Between CCTA and 2DE
LV Functional Parameters CCTA (n = 99) 2DE (n = 99) Pearson' s Correlation Coefficient Bland-Altman Analysis
r p-Value
LVEDV (mL) 100 ± 25 104 ± 28 0.732 < 0.001 -1.0 ± 28.2
LVESV (mL) 34 ± 16 44 ± 20 0.821 < 0.001 -9.7 ± 18.4
LVESV (mL) LVEF (%) 34 ± 16 67 ± 10 44 ± 20 57 ± 14 0.821 0.416 < 0.001 < 0.001 -9.7 ± 18.4 8.9 ± 14.6
SV (mL) 67 ± 18 58 ± 19 0.394 < 0.001 0.5 ± 1.5
CO (L/min) 4.5 ± 1.3 3.9 ± 1.3 0.328 < 0.001 9.2 ± 20.4
LVMM (g) 137 ± 45 186 ± 80 0.764 < 0.001 -38.6 ± 51.9
E/A 1.2 ± 0.5 1.0 ± 0.5 0.807 < 0.005 0.18 ± 0.3
E/E' 10.7 ± 5.8 12.3 ± 6.5 0.751 < 0.005 -1.6 ± 4.4

Data are expressed as the mean ± standard deviation. 2DE = two-dimensional echocardiography, CCTA = coronary computed tomographic angiography, CO = cardiac output, E/A = early (E) to late (A) mitral inflow peak velocities ratio, E/E' = mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (E') ratio, LV = left ventricle, LVEDV = LV end-diastolic volume, LVEF = LV ejection fraction, LVESV = LV end-systolic volume, LVMM = LV myocardial mass, SV = stroke volume

Table 2.
Inter-Observer Agreement of LV Functional Parameters of Coronary CT Angiography Between Two Radiologists
LV Functional Parameters ICC 95% CI p-Value
LVEDV (mL) 0.982 0.929–0.995 < 0.001
LVESV (mL) 0.973 0.896–0.993 < 0.001
LVEF (%) 0.797 0.376–0.946 0.002
SV (mL) 0.923 0.722–0.980 < 0.001
LVMM (g) 0.996 0.983–0.999 < 0.001
E/A 0.976 0.908–0.994 < 0.001
E/E' 0.959 0.843–0.990 < 0.001

CI = confidence interval, E/A = early (E) to late (A) mitral inflow peak velocities ratio, E/E' = mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (E') ratio, ICC = intraclass correlation coefficient, LV = left ventricle, LVEDV = LV end-diastolic volume, LVEF = LV ejection fraction, LVESV = LV end-systolic volume, LVMM = LV myocardial mass, SV = stroke volum

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