HeadtoHead Comparison of Left Ventricular Function Assessment with

Head-to-Head Comparison of Left Ventricular Function Assessment with 64 -Row Computed Tomography, Biplane Left Cineventriculography, and Both Two- and Three-Dimensional Transthoracic Echocardiography: Comparison with Magnetic Resonance Imaging as the Reference Standard Johannes Greupner, MD; Elke Zimmermann, MD; Andrea Grohmann, MD; Hans-Peter Dübel, MD, Ph. D; Till Althoff, MD; Adrian C. Borges, MD, Ph. D; Wolfgang Rutsch, MD, Ph. D; Peter Schlattmann, Ph. D, Bernd Hamm, MD, Ph. D; Marc Dewey, MD, Ph. D

Disclosures Ø Dr. Dewey: grant support from GE Healthcare Biosciences, Bracco, Guerbet, and Toshiba Medical Systems and lecture fees from Toshiba Medical Systems and Bayer (Schering- Berlex). Dr. Dewey is a principal investigator of multicenter studies on cardiac CT (CORE-64 and CORE-320) sponsored by Toshiba Medical Systems. He is also the author of Coronary CT Angiography and Cardiac CT, published by Springer, and offers hands-on workshops on cardiac CT (www. ct-kurs. de). Ø Dr. Hamm: grant support from GE Healthcare, Schering, Siemens Medical Solutions, GE Healthcare, and Toshiba Medical Systems, and lecture fees from Siemens Medical Solutions and Schering.

Objective Ø This study was designed to compare the accuracy of 64 -row contrast computed tomography (CT), invasive cineventriculograhpy (CVG), and both 2 D and 3 D echocardiography (echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI). J Am Coll Cardiol 2012; 59: 1897 -1907

Background Ø Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. Ø Numerous methods are available for assessment of function, but there are limited data comparing these multiple modalities in the same patients. J Am Coll Cardiol 2012; 59: 1897 -1907

Methods Ø A total of 36 patients prospectively underwent 64 -row CT, CVG, 2 D and 3 D echo, and MRI (as the reference standard). Ø Global and regional LV wall motion and ejection fraction (EF) were measured. Ø In addition, assessment of inter-observer agreement was performed. J Am Coll Cardiol 2012; 59: 1897 -1907

Normal LV Function (82 -yo Female) MRI 64 -row CT 2 D Echo 3 D Echo CVG Diastole (top row) and Systole (bottom row) J Am Coll Cardiol 2012; 59: 1897 -1907

Abnormal Regional Function (53 -yo Male) MRI 64 -row CT 2 D Echo 3 D Echo CVG Diastole (top row) and systole (bottom row). During systole, all tests show hypokinesis (arrow) of the anteroseptal myocardial segment (segment 7). Also note thinning of the septal wall (a, b, c) and the darkening of the subendocardial border in this area (a, b), which are due to prior ischemic damage. J Am Coll Cardiol 2012; 59: 1897 -1907

Results Ø For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p<0. 005) (95% confidence intervals, CI: ± 14. 2%) than for CVG (± 20. 2%) and 3 D echo (± 21. 2%). Ø Only CVG (60. 5± 13. 9%; p=0. 03) significantly overestimated EF in comparison to MRI (56. 5 ± 16. 0%). Ø CT showed significantly better agreement for stroke volume than 2 D/3 D echo and CVG. In comparison to MRI, CVG but not CT significantly overestimated the end-diastolic volume (p<0. 001), while 2 D and 3 D echo significantly underestimated the EDV (p<0. 05). Ø There was no significant difference in diagnostic accuracy (range: 76 -88%) for regional LV function assessment among the four modalities when compared to MRI. Ø Inter-observer agreement for EF showed high intraclass correlation (ICC) for 64 -row CT, MRI, and 2 D and 3 D echo (ICC>0. 8) whereas agreement was lower for CVG (ICC=0. 58). J Am Coll Cardiol 2012; 59: 1897 -1907

Summary of the Bland-Altman Analysis of Inter-method Agreement for Global LV Function J Am Coll Cardiol 2012; 59: 1897 -1907

Summary of the Bland-Altman Analysis of Inter-observer Agreement for Global LV Function J Am Coll Cardiol 2012; 59: 1897 -1907

Conclusions Ø 64 -row CT may be more accurate than CVG and 2 D and 3 D echo in comparison to MRI as the reference standard for assessment of global LV function. J Am Coll Cardiol 2012; 59: 1897 -1907