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Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry
Christoph Langer1, M Both, H Harders
1Department of Cardiology, Angiology and Critical Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Schittenhelmstr. 12, 24105, Kiel, Germany, christoph.langer@uksh.de.
Insights
Late enhancement multi-slice computed tomography (leMDCT) accurately measures left ventricular muscle mass (LV-MM) in hypertrophic cardiomyopathy (HCM) patients. This technique shows strong correlation with cardiovascular magnetic resonance (CMR), aiding in risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Late enhancement (LE) on multi-slice computed tomography (leMDCT) visualizes myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM).
- LE is linked to adverse cardiac events, necessitating risk stratification methods.
- Left ventricular muscle mass (LV-MM) derived from leMDCT may offer prognostic value in HCM.
Purpose of the Study:
- To evaluate the accuracy of leMDCT-derived LV muscle mass (LV-MM) for risk stratification in Hypertrophic Cardiomyopathy (HCM).
- To assess the correlation between leMDCT and cardiovascular magnetic resonance (CMR) for LV-MM quantification.
- To determine the optimal contrast agent volume for leMDCT in HCM patients.
Main Methods:
- Twenty-six HCM patients underwent leMDCT and CMR.
- Iodine contrast was administered 7 minutes prior to leMDCT imaging.
- LV-MM was quantified using planimetry on reconstructed cardiac short axis views and correlated with CMR findings.
Main Results:
- leMDCT accurately assessed LV-MM, showing no significant difference compared to CMR in groups with good and sufficient LV contrast.
- Overall intra-/inter-observer variability for LV-MM assessment was low.
- leMDCT-derived measures demonstrated excellent correlation with CMR (r > 0.9).
Conclusions:
- leMDCT enables accurate LV volumetry, including LV-MM assessment, in over 90% of HCM cases.
- leMDCT provides reliable LV planimetry even with relatively low contrast.
- Approximately 2.0 mL/kg body weight of contrast dye is recommended for acceptable leMDCT contrast in HCM.
Objectives:
Late enhancement (LE) multi-slice computed tomography (leMDCT) was introduced for the visualization of (intra-) myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM). LE is associated with adverse cardiac events. This analysis focuses on leMDCT derived LV muscle mass (LV-MM) which may be related to LE resulting in LE proportion for potential risk stratification in HCM.
Methods:
N=26 HCM-patients underwent leMDCT (64-slice-CT) and cardiovascular magnetic resonance (CMR). In leMDCT iodine contrast (Iopromid, 350 mg/mL; 150mL) was injected 7 minutes before imaging. Reconstructed short cardiac axis views served for planimetry. The study group was divided into three groups of varying LV-contrast. LeMDCT was correlated with CMR.
Results:
The mean age was 64.2 ± 14 years. The groups of varying contrast differed in weight and body mass index (p < 0.05). In the group with good LV-contrast assessment of LV-MM resulted in 147.4 ± 64.8 g in leMDCT vs. 147.1 ± 65.9 in CMR (p > 0.05). In the group with sufficient contrast LV-MM appeared with 172 ± 30.8 g in leMDCT vs. 165.9 ± 37.8 in CMR (p > 0.05). Overall intra-/inter-observer variability of semiautomatic assessment of LV-MM showed an accuracy of 0.9 ± 8.6 g and 0.8 ± 9.2 g in leMDCT. All leMDCT-measures correlated well with CMR (r > 0.9).
Conclusions:
LeMDCT primarily performed for LE-visualization in HCM allows for accurate LV-volumetry including LV-MM in > 90% of the cases.
Key Points:
• LeMDCT of relatively low contrast allows for LV planimetry in HCM. • The correlation of leMDCT-based LV volumetry with gold-standard CMR was excellent (r > 0.9). • LeMDCT requires approximately 2.0mL/kgBW of dye to achieve acceptable contrast.
