Reproducibility of Semi-automated Three-dimensional Volumetric Analysis using Cardiac Computed Tomography in Patients With Left Ventricular Assist Device

Multi-detector gated cardiac computed tomography (CCT) allows three-dimensional (3D) quantification of cardiac chambers and is clinically indicated to assess left ventricular assist device (LVAD) malfunction and complications. Automated volumetric analysis is, however, disrupted by inflow cannula ar...

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Published in:Cardiovascular revascularization medicine 2019-05, Vol.20 (5), p.381-386
Main Authors: Gill, Gauravpal S., Weissman, Gaby, Meirovich, Yael F., Medvedofsky, Diego, Mohammed, Selma F., Waksman, Ron, Garcia-Garcia, Hector M.
Format: Article
Language:English
Subjects:
Automation
Cardiac computed tomography
Cardiac-Gated Imaging Techniques
Electrocardiography
Female
Heart Failure - diagnostic imaging
Heart Failure - physiopathology
Heart Failure - therapy
Heart-Assist Devices
Humans
Imaging, Three-Dimensional
Left ventricular assist device
Male
Middle Aged
Multidetector Computed Tomography
Observer Variation
Predictive Value of Tests
Prosthesis Implantation - instrumentation
Reproducibility of Results
Retrospective Studies
Stroke Volume
Treatment Outcome
Ventricular Dysfunction, Left - diagnostic imaging
Ventricular Dysfunction, Left - physiopathology
Ventricular Dysfunction, Left - therapy
Ventricular Function, Left
Volumetric analysis
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Summary:Multi-detector gated cardiac computed tomography (CCT) allows three-dimensional (3D) quantification of cardiac chambers and is clinically indicated to assess left ventricular assist device (LVAD) malfunction and complications. Automated volumetric analysis is, however, disrupted by inflow cannula artifact in patients with LVAD. With this study, we evaluated intra-observer variability in semi-automated 3D cardiac volumetric analysis using CCT in patients with LVADs. Ten clinically indicated CCTs were studied retrospectively from 9 patients with LVADs. 3D chamber quantification included left and right ventricles end-systolic and end-diastolic volumes (ESV, EDV); and left and right atrial ESV. Derived measurements included cardiac output (CO), ejection fraction (EF), and stroke volume (SV). Automated volumetric analysis was performed, and manual corrections were added when necessary. Absolute and relative differences, Bland-Altman plots, and interclass correlation coefficients (ICCs) were used to assess intra-observer reproducibility for these measurements. Intra-observer reproducibility was excellent for volumetric (ICC >0.99) and derived data (ICC >0.91). Comparing right vs left heart volumetric assessments, the former had a higher relative difference (atria 2.8% vs 1.6%, ESV 3.0% vs 1.9%, EDV 2.7% vs 1.3%), which also translated to a greater relative difference in right-side derived data (CO 11.1% vs. 8.8%, EF 10.5% vs. 9.9%, SV 10.9% vs. 9.0%). The mean difference in left ventricular ejection fraction was 0.4% (limits of agreement [LOA]: −2 and 3.2) and right ventricular ejection fraction was 1.2% (LOA: −4.7 and 7.1). Our results for semi-automated 3D volumetric analysis showed excellent reproducibility for both volumetric and derived data. Electrocardiography-gated cardiac computed tomography with semi-automated volumetric analysis has excellent reproducibility in patients with left ventricular assist device making it imaging modality of choice for functional assessment in this patient population, where cardiac magnetic resonance imaging is contraindicated and transthoracic echocardiography may be limited by poor acoustic windows. •Excellent intra-observer reproducibility for volumetric and derived data•Higher relative differences in right heart volumetric assessments•ICCs for derived data relatively lower when compared to volumetric data
ISSN:1553-8389
1878-0938
DOI:10.1016/j.carrev.2019.01.024