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Utility of cardiac CT for evaluating delayed contrast enhancement in dilated cardiomyopathy

Nutzen der kardialen CT zur Beurteilung verzögerter Kontrastverstärkung bei dilatativer Kardiomyopathie

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Abstract

Background

The presence of myocardial fibrosis is associated with adverse outcome in dilated cardiomyopathy (DCM). Delayed contrast-enhanced cardiac magnetic resonance (DE-CMR) currently represents the gold standard in noninvasive evaluation of myocardial scarring. However, a significant number of patients are unable to undergo DE-CMR study for various reasons. We sought to determine the diagnostic accuracy of cardiac CT (CCT) compared with CMR in the investigation of the presence of delayed contrast enhancement (DCE) in subjects with DCM.

Methods

We prospectively enrolled 17 consecutive patients with DCM, who were initially referred to our institution because of recently manifested heart failure due to unexplained left ventricular systolic dysfunction. In all subjects, CCT and DE-CMR were performed within 1 week.

Results

CCT and DE-CMR showed satisfactory agreement in detecting DCE (agreement in 82% cases, κ = 0.56) with 50% sensitivity, 100% specificity, and a positive predictive value of 100%.

Conclusion

CCT may be a valuable method for detecting DCE in patients with DCM. CCT thus might be considered as an alternative method to DE-CMR in the assessment of the presence and extent of myocardial fibrosis in subjects who are not suitable for DE-CMR examination.

Zusammenfassung

Hintergrund

Eine Myokardfibrose geht bei dilatativer Kardiomyopathie („dilated cardiomyopathy“, DCM) mit einem ungünstigen Verlauf einher. Dabei stellt die kardiale Magnetresonanztomographie mit verzögerter Kontrastverstärkung („delayed contrast enhanced cardiac magnetic resonance“, DE-CMR) derzeit den Goldstandard zur nichtinvasiven Beurteilung der myokardialen Vernarbung dar. Jedoch kann bei einer beträchtlichen Anzahl Patienten aus verschiedenen Gründen keine DE-CMR-Untersuchung durchgeführt werden. Ziel der Autoren war es, die diagnostische Genauigkeit der kardialen Computertomographie (CCT) bei der Beurteilung des Vorliegens einer verzögerten Kontrastverstärkung („delayed contrast enhancement“, DCE) bei Patienten mit DCM im Vergleich zur CMR zu ermitteln.

Methoden

Prospektiv wurden 17 konsekutive Patienten mit DCM in die Studie aufgenommen, die initial wegen einer kurz zuvor manifest gewordenen Herzinsuffizienz aufgrund linksventrikulärer systolischer Dysfunktion unklarer Genese an die Klinik der Autoren überwiesen worden waren. Bei allen Teilnehmern wurden die CCT und die DE-CMR innerhalb einer Woche durchgeführt.

Ergebnisse

CCT und DE-CMR wiesen eine befriedigende Übereinstimmung in der Erkennung der DCE auf (Übereinstimmung in 82 % der Fälle, kappa: 0,56) bei einer Sensitivität von 50 %, einer Spezifität von 100 % und einem positiven prädiktiven Wert von 100 %.

Schlussfolgerung

Die CCT stellt möglicherweise eine nützliche Methode zur Erkennung der DCE bei Patienten mit DCM dar. Daher könnte die CCT als Alternativverfahren zur DE-CMR in Betracht gezogen werden, um das Vorliegen und das Ausmaß einer Myokardfibrose bei Patienten zu beurteilen, die sich nicht für eine DE-CMR-Untersuchung eignen.

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References

  1. Elliott P, Andersson B, Arbustini E et al (2008) Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 29:270–276

    Article  PubMed  Google Scholar 

  2. Assomull RG, Prasad SK, Lyne J, Smith G et al (2006) Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 48:1977–1985

    Article  PubMed  Google Scholar 

  3. Scott PA, Rosengarten JA, Curzen NP, Morgan JM (2013) Late gadolinium enhancement cardiac magnetic resonance imaging for the prediction of ventricular tachyarrhythmic events: a meta-analysis. Eur J Heart Fail 15:1019–1027

    Article  CAS  PubMed  Google Scholar 

  4. Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ et al (2014) Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging 7:250–258

    Article  PubMed  Google Scholar 

  5. Zhao L, Ma X, DeLano MC et al (2012) Assessment of myocardial fibrosis and coronary arteries in hypertrophic cardiomyopathy using combined arterial and delayed enhanced CT: comparison with MR and coronary angiography. Eur Radiol 23:1034–1043

    Article  PubMed  Google Scholar 

  6. Zhao L, Ma X, Feuchtner GM et al (2014) Quantification of myocardial delayed enhancement and wall thickness in hypertrophic cardiomyopathy: Multidetector computed tomography versus magnetic resonance imaging. European. J Radiol 83:1778–1785

    Google Scholar 

  7. Zhao L, Ma X, Ge H et al (2014) Diagnostic performance of computed tomography for detection of concomitant coronary disease in hypertrophic cardiomyopathy. Eur Radiol 25:767–775

    Article  PubMed  Google Scholar 

  8. Nieman K, Shapiro MD, Ferencik M et al (2008) Reperfused Myocardial Infarction: Contrast-enhanced 64-Section CT in Comparison to MR Imaging. Radiology 247:49–56

    Article  PubMed  Google Scholar 

  9. Wichmann JL, Arbaciauskaite R, Kerl JM, Frellesen C et al (2014) Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction. Eur Radiol 24:1211–1218

    Article  PubMed  Google Scholar 

  10. Esposito A, Palmisano A, Antunes S, Maccabelli G et al (2016) Cardiac CT with delayed enhancement in the characterization of ventricular tachycardia structural substrate: relationship between CT-segmented scar and electro-anatomic mapping. JACC Cardiovasc Imaging 9:822–832

    Article  PubMed  Google Scholar 

  11. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  12. ICRP (2007) The 2007 recommendations of the international commission on radiological protection. Ann ICRP 37:1–332

    Google Scholar 

  13. Altman DG (1990) Practical statistics for medical research. CRC Press, Boca Raton

    Google Scholar 

  14. Simonetti OP, Kim RJ, Fieno JM et al (2001) An improved MR imaging technique for the visualization of myocardial infarction. Radiology 218:215–223

    Article  CAS  PubMed  Google Scholar 

  15. Ketelsen D, Buchgeister M, Korn A et al (2012) High-pitch computed tomography coronary angiography – a new dose-saving algorithm: estimation of radiation exposure. Radiology Res Pract 2012:e724129

    Google Scholar 

  16. Greupner J, Zimmermann E, Grohmann A, Dübel HP et al (2012) Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2‑ and 3‑dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol 59:1897–1907

    Article  PubMed  Google Scholar 

  17. Koyama Y, Matsuoka H, Mochizuki T et al (2005) Assessment of reperfused acute myocardial infarction with two-phase contrast-enhanced helical CT: prediction of left ventricular function and wall thickness. Radiology 235:804–811

    Article  PubMed  Google Scholar 

  18. Gleeson TG, Bulugahapitiya S (2004) Contrast-induced nephropathy. Am J Roentgenol 183:1673–1689

    Article  Google Scholar 

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Acknowledgements

The project was supported by PRVOUK-P35/LF1/5, Project reg. no. CZ.2.16/3.1.00/24012 from OP Prague Competitiveness.

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Authors and Affiliations

  1. Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic

    V. Cerny, L. Lambert, M. Masek & J. Danes

  2. 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic

    P. Kuchynka, J. Marek, T. Palecek, D. Ambroz & A. Linhart

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  1. V. Cerny
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  2. P. Kuchynka
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Correspondence to P. Kuchynka.

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Conflict of interest

V. Cerny, P. Kuchynka, J. Marek, L. Lambert, M. Masek, T. Palecek, D. Ambroz, A. Linhart, and J. Danes declare that they have no competing interests.

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Cerny, V., Kuchynka, P., Marek, J. et al. Utility of cardiac CT for evaluating delayed contrast enhancement in dilated cardiomyopathy. Herz 42, 776–780 (2017). https://doi.org/10.1007/s00059-016-4515-4

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