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Influence of Left Ventricular Diastolic Dysfunction on the Diagnostic Performance of Coronary Computed Tomography
Zhixin Xie1,2,3, Tianlong Wu2,3, Jing Mu1,2,3
1The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.
Insights
Left ventricular diastolic dysfunction does not impact the diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR). CT-FFR effectively identifies lesion-specific ischemia in patients with and without diastolic dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Performance
Background:
- Left ventricular (LV) diastolic dysfunction is a common condition affecting cardiac function.
- Assessing coronary artery disease (CAD) often involves evaluating myocardial இரத்த ஓட்டம் (blood flow).
- Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) is a non-invasive method to assess the functional significance of coronary stenoses.
Purpose of the Study:
- To investigate the influence of LV diastolic dysfunction on the diagnostic performance of CT-FFR.
- To compare the accuracy of CT-FFR in patients with and without LV diastolic dysfunction.
- To determine if CT-FFR can reliably detect lesion-specific ischemia in the presence of diastolic dysfunction.
Main Methods:
- Retrospective analysis of 100 vessels from 90 patients who underwent echocardiography, CCTA, CT-FFR, invasive coronary angiography (ICA), and FFR.
- Patients were categorized into normal and LV diastolic dysfunction groups based on echocardiographic findings.
- Diagnostic performance metrics (sensitivity, specificity, accuracy, AUC) of CT-FFR were assessed and compared between the groups.
Main Results:
- A strong correlation was observed between CT-FFR and invasive FFR (R = 0.768, p < 0.001).
- Overall diagnostic accuracy for CT-FFR was high (82%).
- Diagnostic performance metrics for CT-FFR were comparable between the normal (87.2% accuracy) and LV diastolic dysfunction (78.7% accuracy) groups, with no significant difference in AUC (0.920 vs. 0.871, p = 0.440).
Conclusions:
- LV diastolic dysfunction does not significantly affect the diagnostic accuracy of CT-FFR.
- CT-FFR demonstrates robust diagnostic performance in identifying lesion-specific ischemia, regardless of LV diastolic function status.
- CT-FFR serves as a valuable non-invasive tool for screening arterial disease and assessing ischemia in patients with potential CAD.
Objectives:
Our study aimed to demonstrate the influence of left ventricular (LV) diastolic dysfunction on the diagnostic performance of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR).
Methods:
One hundred vessels from 90 patients were retrospectively analyzed. All patients underwent echocardiography, coronary computed tomography angiography (CCTA), CT-FFR, invasive coronary angiography (ICA), and fractional flow reserve (FFR). The study population was divided into normal and dysfunction groups according to the LV diastolic function, and the diagnostic performance in both groups was assessed.
Results:
There was a good correlation between CT-FFR and FFR (R = 0.768 p < 0.001) on a per-vessel basis. The sensitivity, specificity, and accuracy were 82.3%, 81.8%, and 82%, respectively. The sensitivity, specificity, and accuracy were 84.6%, 88.5%, and 87.2% in the normal group and 81%, 77.5%, and 78.7% in the dysfunction group, respectively. CT-FFR showed no statistically significant difference in the AUC in the normal group vs. the dysfunction group (AUC: 0.920 [95% CI 0.787-0.983] vs. 0.871 [95% CI 0.761-0.943], Z = 0.772 p = 0.440). However, there was still a good correlation between CT-FFR and FFR in the normal group (R = 0.767, p < 0.001) and dysfunction group (R = 0.767 p < 0.001).
Conclusions:
LV diastolic dysfunction had no effect on the diagnostic accuracy of CT-FFR. CT-FFR has good diagnostic performance in both LV diastolic dysfunction and the normal group and can be used as an effective tool for finding lesion-specific ischemia while screening for arterial disease in patients.
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