Abstract
Delayed-enhanced dual-energy computed tomography (DECT) can evaluate the extent and degree of myocardial fibrosis while coronary CT angiography (CCTA) is a widely accepted coronary artery evaluation method. We sought to describe the role of combined cardiac CT for the evaluation of underlying etiology in patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Sixty-three consecutive patients (31 men, 63 ± 16 years) with newly diagnosed HFrEF were enrolled in this prospective study. Coronary artery disease and myocardial fibrosis were evaluated on CCTA and DECT, respectively, and the tentative underlying etiologies of heart failure (HF) were determined with combinations of findings from both CTs. Concordance between tentative etiologies from cardiac CT and final etiologies from clinical decisions within a 2-year follow-up was assessed. Eighteen patients were diagnosed with ischemic HF on initial cardiac CT, and the final diagnosis was not changed. Another 45 patients with nonischemic HF included tentative etiologies of dilated cardiomyopathy (n = 32, 71.1%), sarcoidosis or myocarditis (n = 8, 17.8%), amyloidosis (n = 2, 4.4%), noncompaction (n = 2, 4.4%) and arrhythmogenic right ventricular cardiomyopathy (n = 1, 2.2%). Five nonischemic HF patients showed different etiologies between initial cardiac CT and clinical decisions. The concordance between cardiac CT and clinical decisions was 92.1%. A high degree of concordance was achieved between tentative etiologies from cardiac CT and final diagnoses from clinical decisions. Combined cardiac CT is a feasible, safe and effective imaging tool for the initial evaluation of newly diagnosed HFrEF patients.
Highlights
Heart failure (HF) is a complex clinical condition that results from any structural or functional impairment of ventricular filling or blood ejection and has increased in prevalence with significant morbidity and mortality worldwide [1,2,3,4]
Prior studies showed that cardiac computed tomography (CT) can be used to evaluate myocardial fibrosis through myocardial delayed enhancement (MDE) imaging in both myocardial infarction and nonischemic cardiomyopathy with similar contrast kinetics for iodinated contrast agent and gadolinium [12,13,14,15]
From March 2014 to February 2015, we found 139 consecutive HF patients with the following inclusion criteria: adult patients (≥20 years of age) who were newly diagnosed with HF with relevant symptoms and signs, and with reduced left ventricular (LV) ejection fraction
Summary
Heart failure (HF) is a complex clinical condition that results from any structural or functional impairment of ventricular filling or blood ejection and has increased in prevalence with significant morbidity and mortality worldwide [1,2,3,4]. In the past few years, multidetector computed tomography (CT) has been developed for cardiovascular imaging, especially for the noninvasive evaluation of coronary artery disease (CAD) [9]. Prior studies showed that cardiac CT can be used to evaluate myocardial fibrosis through myocardial delayed enhancement (MDE) imaging in both myocardial infarction and nonischemic cardiomyopathy with similar contrast kinetics for iodinated contrast agent and gadolinium [12,13,14,15]. A recently developed dual-energy technique could strengthen the role of cardiac CT in MDE evaluation as it improved image quality with increased contrast-to-noise ratio through monochromatic imaging and iodine maps [16,17,18]
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