Evaluation of right ventricular function by coronary computed tomography angiography using a novel automated 3D right ventricle volume segmentation approach: a validation study

• DOI: 10.1007/s00330-018-5523-y
• Publication Date: 2018-06-04T11:40:29Z
• Authors: Philipp Burghard; Fabian Plank; Christoph Beyer; Silvana Müller; Jakob Dörler; Marc-Michael Zaruba; Leo Pölzl; Gerhard Pölzl; Andrea Klauser; Stefan Rauch; Fabian Barbieri; Christian-Ekkehar...; Wilfried Schgoer; Eric E. Williamson; Gudrun Feuchtner
• Keywords: Adult; Heart Failure; Male; Computed Tomography Angiography; Heart Ventricles; Reproducibility of Results; Stroke Volume; Middle Aged; Ventricular Function, Left; 3. Good health; Cardiac Imaging Techniques; 03 medical and health sciences; Imaging, Three-Dimensional; 0302 clinical medicine; Echocardiography; Ventricular Function, Right; Humans; Female; Tomography, X-Ray Computed; Aged

To evaluate right ventricle (RV) function by coronary computed tomography angiography (CTA) using a novel automated three-dimensional (3D) RV volume segmentation tool in comparison with clinical reference modalities.Twenty-six patients with severe end-stage heart failure [left ventricle (LV) ejection fraction (EF) <35%] referred to CTA were enrolled. A specific individually tailored biphasic contrast agent injection protocol was designed (80%/20% high/low flow) was designed. Measurement of RV function [EF, end-diastolic volume (EDV), end-systolic volume (ESV)] by CTA was compared with tricuspid annular plane systolic excursion (TAPSE) by transthoracic echocardiography (TTE) and right heart invasive catheterisation (IC).Automated 3D RV volume segmentation was successful in 26 (100%) patients. Read-out time was 3 min 33 s (range, 1 min 50s-4 min 33s). RV EF by CTA was stronger correlated with right atrial pressure (RAP) by IC (r = -0.595; p = 0.006) but weaker with TAPSE (r = 0.366, p = 0.94). When comparing TAPSE with RAP by IC (r = -0.317, p = 0.231), a weak-to-moderate non-significant inverse correlation was found. Interobserver correlation was high with r = 0.96 (p < 0.001), r = 0.86 (p < 0.001) and r = 0.72 (p = 0.001) for RV EDV, ESV and EF, respectively. CT attenuation of the right atrium (RA) and right ventricle (RV) was 196.9 ± 75.3 and 217.5 ± 76.1 HU, respectively.Measurement of RV function by CTA using a novel 3D volumetric segmentation tool is fast and reliable by applying a dedicated biphasic injection protocol. The RV EF from CTA is a closer surrogate of RAP than TAPSE by TTE.• Evaluation of RV function by cardiac CTA by using a novel 3D volume segmentation tool is fast and reliable. • A biphasic contrast agent injection protocol ensures homogenous RV contrast attenuation. • Cardiac CT is a valuable alternative modality to CMR for the evaluation of RV function.