Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT: Comparison to two-dimensional echocardiography

Ryo Nakazato, Balaji K. Tamarappoo, Thomas W R Smith, Victor Y. Cheng, Damini Dey, Haim Shmilovich, Ariel Gutstein, Swaminatha Gurudevan, Sean W. Hayes, Louise E J Thomson, John D. Friedman, Daniel S. Berman

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Electrocardiographic (ECG)-based tube current modulation during cardiac CT reduces radiation exposure but significantly increases noise in parts of the cardiac cycle where tube current is minimized. Objective: We evaluated the effect of maximal ECG-based tube current reduction on left ventricular (LV) regional wall motion assessment and ejection fraction (EF) by comparing low-radiation helical dual-source CT (DSCT) to 2-dimensional transthoracic echocardiography (2D-TTE). Methods: We studied 83 consecutive patients (15 with prior myocardial infarction) who underwent helically acquired DSCT coronary angiography with maximal ECG-based tube current modulation (low-radiation helical DSCT) and 2D-TTE within a 6-month period (median, 1 day), without any change in clinical status between the studies. In all patients, full tube current was applied only at 70% of the R-R interval, with minimal tube current (4% of maximum) in all other parts of the cardiac cycle. Reduced tube voltage (100 kVp) was combined with the maximal dose modulation in 34 patients. DSCT datasets were evaluated by a blinded, experienced cardiologist. Regional wall motion was assessed with the standard 17-segment model, with each segment scored as normal, hypokinetic, akinetic, and dyskinetic. Results: Mean effective radiation dose for the low-radiation helical DSCT was 5.2 ± 1.7 mSv. Regional wall motion was evaluable in all segments on low-radiation helical DSCT. There was excellent agreement of wall motion scoring by low-radiation helical DSCT and 2D-TTE in 1382 of 1411 segments (98%; Cohen's κ value 0.83; 95% confidence interval, 0.76-0.89; P < 0.0001). Mean LVEF was 67.6% ± 10.3% on low-radiation helical DSCT and 61.8% ± 10.3% on 2D-TTE (P < 0.0001). Conclusion: Low-radiation dose helical coronary CT angiography with maximal ECG-based tube current modulation is comparable to 2D-TTE for regional wall motion and EF assessment.

Original languageEnglish (US)
Pages (from-to)149-157
Number of pages9
JournalJournal of Cardiovascular Computed Tomography
Volume5
Issue number3
DOIs
StatePublished - May 2011

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Echocardiography
Radiation
Coronary Angiography
Spiral Computed Tomography
Noise
Myocardial Infarction
Confidence Intervals

Keywords

  • Dual-source CT
  • ECG-based tube current modulation
  • Low radiation
  • LV function
  • Regional wall motion
  • Two-dimensional echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT : Comparison to two-dimensional echocardiography. / Nakazato, Ryo; Tamarappoo, Balaji K.; Smith, Thomas W R; Cheng, Victor Y.; Dey, Damini; Shmilovich, Haim; Gutstein, Ariel; Gurudevan, Swaminatha; Hayes, Sean W.; Thomson, Louise E J; Friedman, John D.; Berman, Daniel S.

In: Journal of Cardiovascular Computed Tomography, Vol. 5, No. 3, 05.2011, p. 149-157.

Research output: Contribution to journalArticle

Nakazato, R, Tamarappoo, BK, Smith, TWR, Cheng, VY, Dey, D, Shmilovich, H, Gutstein, A, Gurudevan, S, Hayes, SW, Thomson, LEJ, Friedman, JD & Berman, DS 2011, 'Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT: Comparison to two-dimensional echocardiography', Journal of Cardiovascular Computed Tomography, vol. 5, no. 3, pp. 149-157. https://doi.org/10.1016/j.jcct.2011.01.011
Nakazato, Ryo ; Tamarappoo, Balaji K. ; Smith, Thomas W R ; Cheng, Victor Y. ; Dey, Damini ; Shmilovich, Haim ; Gutstein, Ariel ; Gurudevan, Swaminatha ; Hayes, Sean W. ; Thomson, Louise E J ; Friedman, John D. ; Berman, Daniel S. / Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT : Comparison to two-dimensional echocardiography. In: Journal of Cardiovascular Computed Tomography. 2011 ; Vol. 5, No. 3. pp. 149-157.
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abstract = "Background: Electrocardiographic (ECG)-based tube current modulation during cardiac CT reduces radiation exposure but significantly increases noise in parts of the cardiac cycle where tube current is minimized. Objective: We evaluated the effect of maximal ECG-based tube current reduction on left ventricular (LV) regional wall motion assessment and ejection fraction (EF) by comparing low-radiation helical dual-source CT (DSCT) to 2-dimensional transthoracic echocardiography (2D-TTE). Methods: We studied 83 consecutive patients (15 with prior myocardial infarction) who underwent helically acquired DSCT coronary angiography with maximal ECG-based tube current modulation (low-radiation helical DSCT) and 2D-TTE within a 6-month period (median, 1 day), without any change in clinical status between the studies. In all patients, full tube current was applied only at 70{\%} of the R-R interval, with minimal tube current (4{\%} of maximum) in all other parts of the cardiac cycle. Reduced tube voltage (100 kVp) was combined with the maximal dose modulation in 34 patients. DSCT datasets were evaluated by a blinded, experienced cardiologist. Regional wall motion was assessed with the standard 17-segment model, with each segment scored as normal, hypokinetic, akinetic, and dyskinetic. Results: Mean effective radiation dose for the low-radiation helical DSCT was 5.2 ± 1.7 mSv. Regional wall motion was evaluable in all segments on low-radiation helical DSCT. There was excellent agreement of wall motion scoring by low-radiation helical DSCT and 2D-TTE in 1382 of 1411 segments (98{\%}; Cohen's κ value 0.83; 95{\%} confidence interval, 0.76-0.89; P < 0.0001). Mean LVEF was 67.6{\%} ± 10.3{\%} on low-radiation helical DSCT and 61.8{\%} ± 10.3{\%} on 2D-TTE (P < 0.0001). Conclusion: Low-radiation dose helical coronary CT angiography with maximal ECG-based tube current modulation is comparable to 2D-TTE for regional wall motion and EF assessment.",
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T2 - Comparison to two-dimensional echocardiography

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AU - Tamarappoo, Balaji K.

AU - Smith, Thomas W R

AU - Cheng, Victor Y.

AU - Dey, Damini

AU - Shmilovich, Haim

AU - Gutstein, Ariel

AU - Gurudevan, Swaminatha

AU - Hayes, Sean W.

AU - Thomson, Louise E J

AU - Friedman, John D.

AU - Berman, Daniel S.

PY - 2011/5

Y1 - 2011/5

N2 - Background: Electrocardiographic (ECG)-based tube current modulation during cardiac CT reduces radiation exposure but significantly increases noise in parts of the cardiac cycle where tube current is minimized. Objective: We evaluated the effect of maximal ECG-based tube current reduction on left ventricular (LV) regional wall motion assessment and ejection fraction (EF) by comparing low-radiation helical dual-source CT (DSCT) to 2-dimensional transthoracic echocardiography (2D-TTE). Methods: We studied 83 consecutive patients (15 with prior myocardial infarction) who underwent helically acquired DSCT coronary angiography with maximal ECG-based tube current modulation (low-radiation helical DSCT) and 2D-TTE within a 6-month period (median, 1 day), without any change in clinical status between the studies. In all patients, full tube current was applied only at 70% of the R-R interval, with minimal tube current (4% of maximum) in all other parts of the cardiac cycle. Reduced tube voltage (100 kVp) was combined with the maximal dose modulation in 34 patients. DSCT datasets were evaluated by a blinded, experienced cardiologist. Regional wall motion was assessed with the standard 17-segment model, with each segment scored as normal, hypokinetic, akinetic, and dyskinetic. Results: Mean effective radiation dose for the low-radiation helical DSCT was 5.2 ± 1.7 mSv. Regional wall motion was evaluable in all segments on low-radiation helical DSCT. There was excellent agreement of wall motion scoring by low-radiation helical DSCT and 2D-TTE in 1382 of 1411 segments (98%; Cohen's κ value 0.83; 95% confidence interval, 0.76-0.89; P < 0.0001). Mean LVEF was 67.6% ± 10.3% on low-radiation helical DSCT and 61.8% ± 10.3% on 2D-TTE (P < 0.0001). Conclusion: Low-radiation dose helical coronary CT angiography with maximal ECG-based tube current modulation is comparable to 2D-TTE for regional wall motion and EF assessment.

AB - Background: Electrocardiographic (ECG)-based tube current modulation during cardiac CT reduces radiation exposure but significantly increases noise in parts of the cardiac cycle where tube current is minimized. Objective: We evaluated the effect of maximal ECG-based tube current reduction on left ventricular (LV) regional wall motion assessment and ejection fraction (EF) by comparing low-radiation helical dual-source CT (DSCT) to 2-dimensional transthoracic echocardiography (2D-TTE). Methods: We studied 83 consecutive patients (15 with prior myocardial infarction) who underwent helically acquired DSCT coronary angiography with maximal ECG-based tube current modulation (low-radiation helical DSCT) and 2D-TTE within a 6-month period (median, 1 day), without any change in clinical status between the studies. In all patients, full tube current was applied only at 70% of the R-R interval, with minimal tube current (4% of maximum) in all other parts of the cardiac cycle. Reduced tube voltage (100 kVp) was combined with the maximal dose modulation in 34 patients. DSCT datasets were evaluated by a blinded, experienced cardiologist. Regional wall motion was assessed with the standard 17-segment model, with each segment scored as normal, hypokinetic, akinetic, and dyskinetic. Results: Mean effective radiation dose for the low-radiation helical DSCT was 5.2 ± 1.7 mSv. Regional wall motion was evaluable in all segments on low-radiation helical DSCT. There was excellent agreement of wall motion scoring by low-radiation helical DSCT and 2D-TTE in 1382 of 1411 segments (98%; Cohen's κ value 0.83; 95% confidence interval, 0.76-0.89; P < 0.0001). Mean LVEF was 67.6% ± 10.3% on low-radiation helical DSCT and 61.8% ± 10.3% on 2D-TTE (P < 0.0001). Conclusion: Low-radiation dose helical coronary CT angiography with maximal ECG-based tube current modulation is comparable to 2D-TTE for regional wall motion and EF assessment.

KW - Dual-source CT

KW - ECG-based tube current modulation

KW - Low radiation

KW - LV function

KW - Regional wall motion

KW - Two-dimensional echocardiography

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