ABSTRACT
OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is characterized by diastolic dysfunction, which is difficult to assess by noninvasive methods. We hypothesized that measurement of simultaneous left ventricular (LV) and left atrial (LA) volume changes by cardiac computed tomography would be useful in the assessment of diastolic function in HCM. METHODS: We studied 21 patients with HCM and 21 age-matched controls. The LA and LV volumes were calculated and early and late diastolic volume changes derived. RESULTS: The HCM patients had significantly larger LA volumes and reduced LA total emptying fraction (30 ± 7% vs 42 ± 6%; P < 0.0001). Conduit volume was increased (30 ± 6 vs 22 ± 4 mL/m; P < 0.0001) and contributed a significantly higher proportion of total LV diastolic filling, suggesting that passive filling of the LV compensates for LA dysfunction, but at the expense of increased pulmonary filling pressure. CONCLUSIONS: This study suggests that simultaneous depiction of computed tomography-derived LV and LA volume changes can characterize diastolic dysfunction in HCM.
Subject(s)
Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/physiopathology , Diastole/physiology , Tomography, X-Ray Computed , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/physiopathology , Adult , Aged , Cardiomyopathy, Hypertrophic/complications , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Retrospective Studies , Stroke Volume/physiology , Ventricular Dysfunction, Left/complicationsABSTRACT
OBJECTIVE: The purpose of this article is to review the utility of ECG-gated MDCT in evaluating postsurgical findings in aortic and mitral valves. Normal and pathologic findings after aortic and mitral valve corrective surgery are shown in correlation with the findings of the traditionally used imaging modalities echocardiography and fluoroscopy to assist in accurate noninvasive anatomic and dynamic evaluation of postsurgical valvular abnormalities. CONCLUSION: Because of its superior spatial and adequate temporal resolution, ECG-gated MDCT has emerged as a robust diagnostic tool in the evaluation and treatment of patients with postsurgical valvular abnormalities.
Subject(s)
Cardiac-Gated Imaging Techniques/methods , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/surgery , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Multidetector Computed Tomography/methods , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Bicuspid Aortic Valve Disease , Humans , Prognosis , Treatment OutcomeABSTRACT
OBJECTIVES: Evaluating ECG-gated cardiac MDCT detection of systolic anterior motion of the mitral valve, in comparison to trans-thoracic echocardiography as a gold standard. MATERIALS AND METHODS: Study group included 83 consecutive patients (57 men; average age 56.1 years) evaluated with both retrospective ECG-gated cardiac MDCT and trans-thoracic echocardiography within an interval of 30 days. ECG-gated cardiac MDCT imaging was performed with retrospective ECG- gating using 64-slice and 128-slice CT scanners with an inherent temporal resolution range of 75-165 ms. MDCT's and trans- thoracic echocardiograms were retrospectively and independently evaluated by experienced radiologist and cardiologist respectively, for presence of systolic anterior motion of the mitral valve. RESULTS: 7 patients (8.4%) were found to have systolic anterior motion by trans-thoracic echocardiography, from which 6 were found to have systolic anterior motion by ECG-gated cardiac MDCT. Of the 76 patients without systolic anterior motion on trans-thoracic echocardiography, all were correctly identified using ECG-gated cardiac MDCT. The sensitivity, specificity, positive and negative predictive values and accuracy of ECG-gated cardiac MDCT in identifying systolic anterior motion of the mitral valve were 85.7% (6/7), 100% (76/76), 100% (6/6), 98.7% (76/77) and 98.8% (82/83), respectively. CONCLUSION: ECG-gated cardiac MDCT is comparable to trans-thoracic echocardiography in detecting systolic anterior motion of the mitral valve.
Subject(s)
Cardiomyopathies/diagnosis , Echocardiography/instrumentation , Mitral Valve/physiopathology , Multidetector Computed Tomography/instrumentation , Systole/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Echocardiography/methods , Female , Humans , Linear Models , Male , Middle Aged , Multidetector Computed Tomography/methods , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
Coronary artery dissection (CD) is a rare cause of acute myocardial ischemia. It is often diagnosed by invasive coronary angiography, which is the principal diagnostic tool and gold standard in the diagnosis and triage of patients with CD. More recently, electrocardiogram-gated multidetector computerized tomography has emerged as a complementary imaging tool primarily for follow-up purposes. To our knowledge, this is the first published report of the primary diagnosis and dynamic cine interrogation of a left main CD using retrospective electrocardiogram-gated multidetector computerized tomography, which was not disclosed on invasive coronary angiography.