Cardiac CT Provides Complementary Parameters of Right Ventricle Function in LVAD Patients

Abstract

Purpose Patients receiving LVADs are at risk for post-operative right ventricular (RV) failure. Cardiac CT angiography (CTA) provides 3D isotropic spatial resolution and blood pool-myocardial delineation and can be used to assess ventricular volumes. We sought to evaluate whether right heart catheterization (RHC) and echocardiographic (echo) parameters of RV structure and function correlate with CT-derived parameters - specifically, RV ejection fraction RVEF, RV stroke volume index RVSVI, RV to LV end diastolic ratio RV-LVEDR, and RV end diastolic volume index RVEDVI. Methods 11 LVAD candidates (age 55 ± 12, 10 males) underwent cardiac CTA between 9/27/2017 and 10/16/2018. All patients had contemporaneous (within 7 days) echo examinations and 7 patients had contemporaneous RHCs. Pulmonary artery pulsatility index PAPI, RV stroke work index RVSWI, and the ratio of right atrial to pulmonary capillary wedge pressure RAP/PCWP were obtained from RHC reports and RV size, global function, and tricuspid annular plane systolic excursion (TAPSE) were obtained from echo reports. Ventricle size was graded as small, normal, mild, moderate, or severely enlarged, and ventricle function as normal or depressed. Pearson's correlation coefficient (ρ) was calculated for each relationship. For echo-derived ventricular function, an unpaired t-test (p Results Structurally, echo derived RV size correlated moderately with CT RV EDVI and RAP/PCWP correlated strongly with RV-LVEDR. Functionally, RV SWI correlated well with RV EF and RV SVI. PAPI poorly correlated to RV EF and RV SVI. Echo-based characterization of global RV function was not associated with any CT-derived measures (p > 0.1). Conclusion CT-derived RV parameters may provide complementary information to hemodynamic and echo assessment, especially RAP/PCWP and 2D echo parameters, and when combined could lead to comprehensive assessment of RV function. Further research is required to examine the relationship between TAPSE and RV EF.