Assessment of global and regional left ventricular function and volumes with 64-slice multi-slice computed tomography: a comparison with 2D echocardiography

Introduction: In patients with coronary artery disease (CAD), LV function and volumes are important parameters for long-term prognosis. 64-slice MSCT allows non-invasive assessment of the coronary arteries, but the accuracy of 64-slice MSCT for assessment of LV volumes and function is unknown. Methods: A head-to-head comparison between 64-slice MSCT and 2D echocardiography was performed in 40 patients with known or suspected CAD. The LV end-diastolic (LVEDV) and LV end-systolic volume (LVESV) were determined and LV ejection fraction (LVEF) was derived. Regional wall motion was assessed visually using a 17-segment model. A 3-point scoring system was used to assign to each segment a wall motion score: 1=normokinesia, 2=hypokinesia, 3=a- or dyskinesia. 2D echocardiography served as gold standard. Results: MSCT agreed well with 2D echocardiography for assessment of LVEDV (r=0.97; P <0.0001) and LVESV (r=0.98; P <0.0001). An excellent correlation between MSCT and 2D echocardiography was shown for evaluation of LVEF (r=0.91; P <0.0001). Agreement for assessment of regional wall motion was excellent (96%, κ=0.82). Conclusions: Accurate assessment of global and regional LV function and volumes is feasible with 64-slice MSCT. LV function, LV ejection fraction and LV volumes were assessed and compared with 2D echocardiography. 2D echocardiography and MSCT were performed within one month of each other. Patients with (supra-) ventricular arrhythmias were excluded, as well as patients with renal insuﬃciency (serum creatinine >120 mmol/l) and known allergy to iodine contrast media. All patients provided informed consent to the study protocol, which was approved by the local ethics committee. to the of and and show excellent correlations between MSCT and 2D echocardiography for LVEDV, LVESV and LVEF. The overall agreement of regional wall motion was excellent, with 96% of the segments scored identically on both imaging modalities (κ=0.82). The agreements for the individual gradings of regional wall motion (normokinesia, hypokinesia, and a- or dyskinesia) were 99%, 70%, and 78%, respectively. It be noted however, that LV ejection fraction was well preserved in the majority of our study population, and limited wall motion abnormalities were present. This could reduce the correlation between the 2 techniques in general practice. To our knowledge, this is the ﬁrst study to compare 64-slice MSCT with 2D echocardiography for the evaluation of LV function and LV volumes. good agreement between the two techniques for assessing these LV et that LV function measurements as derived from 16-slice MSCT correlated well with 2D echocardiography. The ﬁndings in the current study with 64-slice MSCT technology extrapolate these earlier ﬁndings with 4- and 16-slice MSCT. an underestimation of LVEDV by MSCT was observed compared to 2D echocardiography. Recent studies low-power contrast echocardiography is more accurate than unenhanced harmonic echocardiography for the assessment of LVEDV and LVESV as compared to CMR as gold standard. In both studies, LV volumes were underestimated by contrast enhanced echocardiography compared with CMR. Extrapolating these observations to the present study would suggest a further underestimation of LV volumes. Nevertheless, Yamamuro et al. 22 showed a good correlation for the assessment of LV volumes and LV function between 8-slice MSCT and CMR. A direct comparison between 64-slice MSCT and CMR is needed to investigate the performance of 64-slice MSCT for the assessment of LV volumes and LV function.