CT 肺动脉造影诊断急性心力衰竭的可行性和准确性。

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy.

机构信息

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

出版信息

Eur Radiol. 2022 Aug;32(8):5287-5296. doi: 10.1007/s00330-022-08676-9. Epub 2022 Mar 16.

DOI:10.1007/s00330-022-08676-9

PMID:35294585

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8924734/

Abstract

OBJECTIVES

To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients.

METHODS

In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HU) and difference (HU) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis.

RESULTS

Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980-0.991). NT-pro BNP exhibited moderate correlations with HU (r = 0.50, p < 0.001) and HU (r = 0.50, p < 0.001). In the training cohort, HU (AUC: 0.89, 95%CI: 0.82-0.95) and HU (AUC: 0.88, 95%CI: 0.81-0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HU (sensitivity 93%; specificity 75%) and 113 for HU (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HU and HU, respectively.

CONCLUSION

In emergency department patients undergoing CTPA and showing no PE, both HU and HU have a high sensitivity for diagnosing acute HF.

KEY POINTS

• Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.

摘要

目的

评估 CT 肺动脉造影（CTPA）在急诊科患者中诊断急性心力衰竭（HF）的可行性和准确性。

方法

在这项回顾性单中心研究中，我们评估了 150 名在急诊科接受 CTPA 检查的患者（平均年龄 65±17 岁），这些患者进行了固定扫描（100 kVp）和对比剂方案（60 mL，4 mL/s），且无肺栓塞（PE）。患者被分为训练队列（n=100）和测试队列（n=50）。三位独立的、盲法的读者在轴位图像上测量右心室（RV）和左心室（LV）的衰减。计算 RV 和 LV 衰减之间的比值（HU）和差值（HU）。急性 HF 的诊断基于临床、实验室和超声心动图数据。使用受试者工作特征分析的曲线下面积（AUC）计算最佳阈值、灵敏度和特异性。

结果

150 名患者中有 59 名（40%）被诊断为急性 HF。衰减测量显示出几乎完美的观察者间一致性（组内相关系数：0.986，95%CI：0.980-0.991）。NT-pro BNP 与 HU（r=0.50，p<0.001）和 HU（r=0.50，p<0.001）呈中度相关。在训练队列中，HU（AUC：0.89，95%CI：0.82-0.95）和 HU（AUC：0.88，95%CI：0.81-0.95）显示出非常好的 HF 诊断性能。最佳截断值为 HU 为 1.42（灵敏度 93%；特异性 75%），HU 为 113（灵敏度 93%；特异性 73%）。将这些阈值应用于测试队列，HU 和 HU 的灵敏度分别为 89%和 89%，特异性分别为 69%和 63%。