Ariel Schweitzer1, Yoram Agmon2, Doron Aronson3, Sobhi Abadi4, Diab Mutlak5, Shemy Carasso6, Jonathan R Walker7, Jonathan Lessick8. 1. Cardiology Department, Haaliya Street, Haifa 31096, Israel. Electronic address: ariel.schw@gmail.com. 2. Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: agmon@rambam.health.gov.il. 3. Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: d_aronson@rambam.health.gov.il. 4. Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, Haifa 31096, Israel. Electronic address: s_abadi@rambam.health.gov.il. 5. Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: d_mutlak@rambam.health.gov.il. 6. Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: shemy.carasso@gmail.com. 7. Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: walkerjr@me.com. 8. Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel. Electronic address: j_lessick@rambam.health.gov.il.
Abstract
BACKGROUND: Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying. OBJECTIVE: To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography. METHODS: We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change. RESULTS: Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD. CONCLUSIONS: DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.
BACKGROUND:Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying. OBJECTIVE: To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography. METHODS: We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change. RESULTS:Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD. CONCLUSIONS:DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.
Authors: Anna Degiovanni; Enrico Boggio; Eleonora Prenna; Chiara Sartori; Federica De Vecchi; Paolo N Marino Journal: Clin Res Cardiol Date: 2017-11-27 Impact factor: 5.460
Authors: Waqar Aziz; Simon Claridge; Ioannis Ntalas; Justin Gould; Adelaide de Vecchi; Orod Razeghi; Daniel Toth; Peter Mountney; Rebecca Preston; Christopher A Rinaldi; Reza Razavi; Steven Niederer; Ronak Rajani Journal: ESC Heart Fail Date: 2019-08-10