Anto Sedlic MD, Abstract Co-Author: Nothing to Disclose

Elena Scali MD, Presenter: Nothing to Disclose

Savvas Nicolaou MD, Abstract Co-Author: Nothing to Disclose

John R. Mayo MD, Abstract Co-Author: Speaker, Siemens AG

Left ventricle (LV) diastolic dysfunction in the setting of heart failure with preserved ejection fraction is a diagnostic and therapeutic challenge with significant associated morbidity and mortality. Diastolic dysfunction is associated with abnormal LV relaxation or increased LV stiffness. Although catheterization is the gold standard in evaluation of diastolic dysfunction, the diagnosis is usually made by echocardiography. In patients undergoing retrospective cardiac computed tomography angiography (CTA), functional data can be used to quantify LV volume over time to measure the rate of LV diastolic filling in diastolic dysfunction.

20 patients undergoing cardiac CTA were reviewed for CT evidence of diastolic dysfunction. All patients had diastolic dysfunction on echocardiography with preserved systolic function. Retrospective CTA was performed and LV filling curves were obtained from the functional images by application of post-processing software. LV volume was measured at 5% intervals over the cardiac cycle. LV volume versus time was plotted and the slope measured at various points in diastole to compare LV filling velocity in both groups. LV filling rates in early diastole, after mitral valve opening, was compared between patients with diastolic dysfunction and patients with normal diastolic function. LV filling due to left atrial contraction (A wave) was also measured in both groups and quantified as percent of total stroke volume.

In patients with diastolic dysfunction, early LV filling is impaired. Comparing patients with preserved LV ejection fraction, the early diastolic LV filling rate was measured at 218.4 ml/sec (95% CI: 199.7 to 237.5) compared to 308.6 ml/sec (95% CI: 278 to 338.6) for normal controls. LA contraction (A wave contribution) was also demonstrated to contribute to LV stroke volume filling to a greater extent in the diastolic dysfunction group, however, initial results did not demonstrate a statistically significant difference in volume.

Initial results demonstrate that functional cardiac CTA can identify patients with left ventricular diastolic dysfunction and may have a role in the assessment and quantification of diastolic dysfunction.

Diastolic dysfunction is a diagnostic challenge that can be identified and quantified with functional cardiac CTA.

Sedlic, A, Scali, E, Nicolaou, S, Mayo, J, The Utility of Cardiac CT in Evaluating Left Ventricular Diastolic Dysfunction.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017403.html