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Assessment of left ventricular ejection fraction using low radiation dose computed tomography

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

An Erratum to this article was published on 20 June 2015

Abstract

Background

Cardiac CT is a non-invasive modality with the ability to estimate LVEF. However, given its limited temporal resolution and radiation, there has been initial resistance to use CT to measure LVEF. Developing an accurate, fast, low radiation dose protocol is desirable.

Objective

The objective of this study is to demonstrate that a ‘low radiation dose’ 64 slice cardiac computed tomography (CT) protocol is feasible and can accurately measure left ventricular ejection fraction (LVEF) while delivering a radiation dose lower than radionuclide angiography (RNA).

Methods

Patients undergoing RNA were prospectively screened and enrolled to undergo a ‘low-dose’ 64 slice CT LVEF protocol. LVEF measures, duration of each study and radiation dose between CT and RNA were compared.

Results

A total of 77 patients (mean age = 61.8 ± 12.2 years and 58 men) were analyzed. The mean LVEF measured by CT and RNA were 41.9 ± 15.2% and 39.4 ± 13.9%, respectively, (P = 0.154) with a good correlation (r = 0.863). Bland-Altman plot revealed a good agreement between the CT and RNA LVEF (mean difference of −2.4). There was good agreement between CT LVEF and RNA for identifying patients with LVEF ≤30% (kappa = 0.693) and LVEF ≥50% (kappa = 0.749). The mean dose estimated effective dose for CT and RNA were 4.7 ± 1.6 and 9.5 ± 1.0 mSv, respectively. The mean CT LVEF imaging duration (4:32 ± 3:05 minutes) was significantly shorter than the RNA image acquisition time (9:05 ± 2:36 minutes; p < 0.001).

Conclusion

The results of our study suggest that low-dose CT LVEF protocol is feasible, accurate, and fast while delivering a lower radiation dose than traditional RNA.

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References

  1. Sanz G, Castaner A, Betriu A, Magrina J, Roig E, Coll S, et al. Determinants of prognosis in survivors of myocardial infarction. N Engl J Med 1982;306:1065-70.

    Article  CAS  PubMed  Google Scholar 

  2. Taylor GJ, Humphries JO, Mellits ED, Pitt B, Schulze RA, Griffith LS, et al. Predictors of clinical course, coronary anatomy and left ventricular function after recovery from acute myocardial infarction. Circulation 1980;62:960-70.

    Article  CAS  PubMed  Google Scholar 

  3. White HD, Norris RM, Brown MA, Brandt PWT, Whitlock RML, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987;76:44-51.

    Article  CAS  PubMed  Google Scholar 

  4. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol 2004;44:1146-54.

    Article  Google Scholar 

  5. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006;48:e247-346.

    Article  PubMed  Google Scholar 

  6. Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA, et al. AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With the Heart Rhythm Society. J Am Coll Cardiol 2006;47:473-84.

    Article  PubMed  Google Scholar 

  7. Hunt SA. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005;46:e1-82.

    Article  PubMed  Google Scholar 

  8. McAlister FA, Ezekowitz J, Hooton N, Vandermeer B, Spooner C, Dryden DM, et al. Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: A systematic review. JAMA 2007;297:2502-14.

    Article  CAS  PubMed  Google Scholar 

  9. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Jr Faxon DP, Freed MD, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;52:e1-148.

    Article  PubMed  Google Scholar 

  10. Russo AM, Stainback RF, Bailey SR, Epstein AE, Heidenreich PA, Jessup M, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2013;61:1318-68.

    Article  PubMed  Google Scholar 

  11. Chow BJW, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A, et al. Prognostic value of 64-slice cardiac computed tomography: Severity of coronary artery disease, coronary atherosclerosis and left ventricular ejection fraction. J Am Coll Cardiol 2010;55:1017-28.

    Article  PubMed  Google Scholar 

  12. Butler J, Shapiro MD, Jassal D, Neilan T, Nichols J, Ferencik M, 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;99:247-9.

    Article  PubMed  Google Scholar 

  13. Dewey M, Muller M, Eddicks S, Schnapauff D, Teige F, Rutsch W, 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;48:2034-44.

    Article  PubMed  Google Scholar 

  14. Henneman MM, Schuijf JD, Jukema JW, Holman ER, Lamb HJ, de Roos A, 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;13:480-7.

    Article  PubMed  Google Scholar 

  15. Schuijf JD, Bax JJ, Jukema JW, Lamb HJ, Salm LP, de Roos A, 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;116:201-5.

    Article  CAS  PubMed  Google Scholar 

  16. Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, et al. 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 2006;114:654-61.

    Article  PubMed  Google Scholar 

  17. Schepis T, Gaemperli O, Koepfli P, Valenta I, Strobel K, Brunner A, et al. Comparison of 64-Slice CT with Gated SPECT for Evaluation of Left Ventricular Function. J Nucl Med 2006;47:1288-94.

    PubMed  Google Scholar 

  18. Henneman MM, Schuijf JD, Jukema JW, Lamb HJ, de Roos A, Dibbets P, et al. Comprehensive cardiac assessment with multislice computed tomography: Evaluation of left ventricular function and perfusion in addition to coronary anatomy in patients with previous myocardial infarction. Heart 2006;92:1779-83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kim IJ, Choo KS, Lee JS, Kim SJ, Kim JH, Kim YK, et al. Comparison of gated blood pool SPECT and multi-detector row computed tomography for measurements of left ventricular volumes and ejection fraction in patients with atypical chest pain: Validation with radionuclide ventriculography. Cardiology 2007;107:8-16.

    Article  PubMed  Google Scholar 

  20. Chow BJW, Abraham A, Wells GA, Chen L, Ruddy TD, Yam Y, et al. Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging 2009;2:16-23.

    Article  Google Scholar 

  21. Abbara S, Chow BJW, Pena AJ, Cury RC, Hoffmann U, Nieman K, et al. Assessment of left ventricular function with 16- and 64- slice multi-detector computed tomography. Eur J Radiol 2008;67:481-6.

    Article  PubMed  Google Scholar 

  22. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A, et al. 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 2008;1:782-6.

    Article  PubMed  Google Scholar 

  23. Beck-da-Silva L, De Bold A, Davies RA, Chow BJW, Ruddy TD, Fraser M, et al. Effect of bisoprolol on right ventricular function and brain natriuretic peptide in patients with heart failure. Congest Heart Fail 2004;10:127-32.

    Article  CAS  PubMed  Google Scholar 

  24. American Society of Nuclear Cardiology. Updated imaging guidelines for nuclear cardiology procedures, part 1. J Nucl Cardiol 2001;8:G5-58.

    Article  Google Scholar 

  25. Chow BJW, Abunassar JG, Ascah K, deKemp R, DaSilva J, Mesana T, et al. Effects of mitral valve surgery on myocardial energetics in patients with severe mitral regurgitation. Circ Cardiovasc Imaging 2010;3:308-13.

    Article  PubMed  Google Scholar 

  26. Massardo T, Gal RA, Grenier RP, Schmidt DH. Left ventricular volume calculation using a count-based ratio method applied to multigated radionucide angiography. J Nucl Med 1990;31:450-6.

    CAS  PubMed  Google Scholar 

  27. McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology 2014;273:714-25.

    Article  PubMed  Google Scholar 

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Acknowledgments

Benjamin Chow is supported by the Saul and Edna Goldfarb Chair in Cardiac Imaging and receives research support from GE Healthcare and educational support from TeraRecon Inc. The study was funded in part by the UOHIAMO Innovations Fund.

Disclosures

No other authors have conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada

    YiQi Yang, Yeung Yam BSc, Ahmed Aljizeeri MD, Siamak Aliyary Ghraboghly MD, Ibraheem Al-Harbi MBBS, Ally Pen PhD, Terrence D. Ruddy MD, FRCPC, FACC, FASNC & Benjamin J. W. Chow MD, FRCPC, FACC, FASNC, FSCCT

  2. Department of Radiology, University of Ottawa, Ottawa, Canada

    Terrence D. Ruddy MD, FRCPC, FACC, FASNC & Benjamin J. W. Chow MD, FRCPC, FACC, FASNC, FSCCT

  3. Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada

    Li Chen MSc

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  1. YiQi Yang
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  2. Yeung Yam BSc
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  3. Li Chen MSc
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  4. Ahmed Aljizeeri MD
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  8. Terrence D. Ruddy MD, FRCPC, FACC, FASNC
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  9. Benjamin J. W. Chow MD, FRCPC, FACC, FASNC, FSCCT
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Corresponding author

Correspondence to Benjamin J. W. Chow MD, FRCPC, FACC, FASNC, FSCCT.

Additional information

See related editorial, doi:10.1007/s12350-015-0183-7.

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Yang, Y., Yam, Y., Chen, L. et al. Assessment of left ventricular ejection fraction using low radiation dose computed tomography. J. Nucl. Cardiol. 23, 414–421 (2016). https://doi.org/10.1007/s12350-015-0123-6

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  • DOI: https://doi.org/10.1007/s12350-015-0123-6

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