Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography.
BACKGROUND
Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying.


OBJECTIVE
To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography.


METHODS
We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change.


RESULTS
Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD.


CONCLUSIONS
DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.
['Schweitzer|Ariel|A|', 'Agmon|Yoram|Y|', 'Aronson|Doron|D|', 'Abadi|Sobhi|S|', 'Mutlak|Diab|D|', 'Carasso|Shemy|S|', 'Walker|Jonathan R|JR|', 'Lessick|Jonathan|J|']
D000368:Aged D016279:Atrial Function, Left D062185:Atrial Pressure D001783:Blood Flow Velocity D002302:Cardiac Output D002306:Cardiac Volume D016022:Case-Control Studies D003971:Diastole D015150:Echocardiography, Doppler D017548:Echocardiography, Transesophageal D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D008943:Mitral Valve D009200:Myocardial Contraction D011669:Pulmonary Wedge Pressure D012680:Sensitivity and Specificity D013318:Stroke Volume D013599:Systole D014057:Tomography, X-Ray Computed D018487:Ventricular Dysfunction, Left D016277:Ventricular Function, Left
Conduit volume Atrial function Atrial volume Coronary CT angiography Heart failure Left ventricular mass