Kumar Amy Fiona Suresh, Ojha Vineeta, Veettil Sreelal Thazhathu, Mantoo Mohsin, Singh Damandeep, Pandey Niraj Nirmal, Jagia Priya, Yadav Satyavir, Kumar Sanjeev
Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Echocardiography. 2025 Jan;42(1):e70069. doi: 10.1111/echo.70069.
Diastolic dysfunction (DD) is defined as impaired left ventricular (LV) relaxation, caused by structural or functional heart diseases. We sought to assess the role of cardiac CT angiography (CCTA) as a tool to evaluate LV DD in patients with normal EF using the diastolic expansion index (DEI), as compared to transthoracic echocardiography (TTE) as the gold standard.
Patients presenting with atypical chest pain with suspected coronary artery disease (CAD) and having a normal LV ejection fraction on TTE underwent CCTA using a dual source CT scanner. Assessment of diastolic function on CCTA was done using DEI, and it was compared with TTE-derived diastolic function as per standard ASE/EACVI guidelines. DEI was measured using a dedicated postprocessing software (Syngo.via VB20, Siemens Healthcare, Germany) and was calculated as a ratio of maximum LV volume (in LV end-diastole) to maximum left atrial (LA) volume (in LV end-systole), with the mean value of readings from three independent readers taken for each calculation.
The study included 141 patients (60 male; mean age 50.82 ± 10.20 years; mean heart rate 84.90 ± 16.15 beats per minute). CCTA-derived mean indexed LA volumes correlated well with TTE measurements but were larger when compared to TTE (r = 0.53, p < 0.0001). A progressive increase in LA volume index was noted with worsening DD grades. Excellent inter-observer correlation was seen between the three observers for LA volume index (intra-class correlation coefficient: 0.999 [95% CI: 0.999-0.999] and for DEI 0.996 [95% CI: 0.995-0.997]). A normal LV diastolic function was predicted by a DEI > 1.57 with a specificity and sensitivity of 88.3% and 81.6%, respectively (area under curve (AUC)-0.87), whereas an abnormal LV diastolic function was predicted by DEI <1.46 with a specificity and sensitivity of 84.8% and 62.5%, respectively (AUC-0.848). There was a significant correlation between the presence of obstructive CAD and an increase in calcium score with DD grade (p = 0.006 and 0.001, respectively).
CCTA-derived DEI is a reliable metric for assessing LV diastolic dysfunction in patients with suspected CAD with normal ejection fraction. The presence of obstructive CAD and an increase in calcium score correlated with worsening DD grade.
舒张功能障碍（DD）定义为因结构性或功能性心脏病导致的左心室（LV）舒张受损。我们试图评估心脏CT血管造影（CCTA）作为一种工具，与作为金标准的经胸超声心动图（TTE）相比，使用舒张期扩张指数（DEI）来评估左心室舒张功能正常的患者的左心室舒张功能障碍。
因非典型胸痛疑似冠心病（CAD）且经胸超声心动图显示左心室射血分数正常的患者，使用双源CT扫描仪进行CCTA检查。通过DEI对CCTA上的舒张功能进行评估，并根据ASE/EACVI标准指南将其与经胸超声心动图得出的舒张功能进行比较。使用专用后处理软件（Syngo.via VB20，德国西门子医疗公司）测量DEI，并将其计算为左心室最大容积（左心室舒张末期）与左心房最大容积（左心室收缩末期）的比值，每次计算取三位独立阅片者读数的平均值。
该研究纳入了141例患者（60例男性；平均年龄50.82±10.20岁；平均心率84.90±16.15次/分钟）。CCTA得出的平均左心房指数容积与经胸超声心动图测量结果相关性良好，但与经胸超声心动图相比更大（r = 0.53，p < 0.0001）。随着舒张功能障碍分级加重，左心房容积指数逐渐增加。三位观察者对左心房容积指数的观察者间相关性极佳（组内相关系数：0.999 [95% CI：0.999 - 0.999]），对DEI的观察者间相关性也极佳（0.996 [95% CI：0.995 - 0.997]）。DEI > 1.57时预测左心室舒张功能正常，特异性和敏感性分别为88.3%和81.6%（曲线下面积（AUC）- 0.87），而DEI < 1.46时预测左心室舒张功能异常，特异性和敏感性分别为84.8%和62.5%（AUC - 0.848）。阻塞性CAD的存在以及钙化积分的增加与舒张功能障碍分级之间存在显著相关性（分别为p = 0.006和0.001）。
CCTA得出的DEI是评估射血分数正常的疑似CAD患者左心室舒张功能障碍的可靠指标。阻塞性CAD的存在以及钙化积分的增加与舒张功能障碍分级加重相关。
