Cheong Daniel, Alloah Qais, Fishbein Joanna S, Rajagopal Hari G
Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA.
Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, USA.
Pediatr Cardiol. 2025 Apr;46(4):844-852. doi: 10.1007/s00246-024-03504-x. Epub 2024 Apr 30.
Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.
前瞻性心电图(ECG)触发的心血管计算机断层扫描(CCT)主要用于获取先天性心脏病(CHD)的解剖学信息,尚未用于计算舒张末期容积(EDV);然而,可以测量舒张中期容积(MDV)。本研究的目的是评估心室EDV和MDV测量的可行性及两者之间的一致性。在连续450例CCT研究中,对31例回顾性ECG门控CCT进行了分析。使用syngo.via对CCT图像进行处理,自动勾勒轮廓,然后在舒张末期和舒张中期(在心动周期的70%时测量)手动调整左心室(LV)和右心室(RV)的心内膜边界。分别使用Spearman等级系数和组内相关系数(ICC)来证明EDV和MDV之间的相关性和一致性。平均年龄±标准差为28.8±12.5岁,男性19例(61.3%),最常见的诊断是法洛四联症(TOF)(58.1%),35%(11/31)的患者有起搏器、植入式心律转复除颤器(ICD)或其他CMRI的禁忌证,23%(7/31)有幽闭恐惧症,6.5%(2/31)有发育迟缓且拒绝镇静,这些患者之前未进行过CMRI检查。左心室EDV指数和左心室MDV指数的平均值±标准差分别为91.1±24.5和84.8±22.3 ml/m。右心室EDV指数和右心室MDV指数的平均值±标准差分别为136.8±41和130.2±41.5 ml/m。EDV和MDV具有很强的正相关性和良好的一致性(左心室ICC为0.92,右心室ICC为0.95)。在右心室扩张(右心室EDV指数z评分>2)的一部分患者(21例)中,这种一致性得以保持。观察者内信度(左心室和右心室MDV分别为0.97和0.98)和观察者间信度(左心室和右心室MDV分别为0.96和0.90)都非常好。在一组特定的CHD患者中,通过CCT测量MDV是可行的,并且这些值与EDV有良好的一致性。这可用于从前瞻性ECG触发的CCT研究中获取功能数据。需要进一步的大规模分析来确定准确性和临床相关性。