Diagnostic Value of Quantitative Lung Computed Tomography to Detect Clinical Heart Failure in Patients with Non-St-Elevation Myocardial Infarction
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 15, Issue 1
Abstract
Heart failure (HF) is associated with increased mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI) [1]. The pathophysiology behind is myocardial ischemia leading to cardiac dysfunction, elevated left ventricular filling pressures, accumulation of of fluid in the lungs [2] and, in severe cases, pulmonary edema [3]. However, most patients with NSTEMI do not display obvious signs and symptoms of heart failure despite cardiac dysfunction. Instead they have subtle symptoms and signs where clinical evaluation and chest x-ray have low sensitivity [4] and low interobserver reproducibility [5,6]. Thus, identifying heart failure accurately in patients with subclinical congestion is a major clinical challenge as well as an unmet need. Computed tomography (CT) evaluation of congestion is considered superior to chest x-ray, but restricted due to relative high radiation exposure [7]. Cardiac CT however is expanding rapidly and on the verge of becoming first diagnostic test in patients with NSTEMI [8,9]. We have previously examined qualitative signs of congestion from Cardiac-CT images in NSTEMI patients and found that even modest qualitative CT signs of heart failure were associated with adverse prognosis [10]. However, qualitative assessment of radiographic CT signs of congestion requires an in-house specialist, time consuming and is subject to interobserver variability [10]. Quantitative lung computed tomography is a well-known non-invasive technique that has been used objectively to assess lung involvement in interstitial lung disease [11]. Quantitative CT derived lung attenuation density was strongly correlated to the development of pulmonary edema in experimental animal studies [12] and previous studies suggested that a quantitative CT assessment may detect subclinical pulmonary congestion [13,14]. The potential prognostic and therapeutic value of detecting subclinical pulmonary congestion from already performed CT scans warrant a study to investigate the best way to perform quantitative CT analysis in terms of diagnostic accuracy and reproducibility. Thus, we designed a proof of concept case control study to examine the reproducibility and diagnostic value of different quantitative CT methods in patients with and without definite signs of heart failure after NSTEMI. We hypothesized that patients with NSTEMI and definite heart failure prior to the CT-scan would have a higher lung density, than patients with NSTEMI and no clinical signs of heart failure. The objective was to examine which of the previously described quantitative CT based methods are best to discriminate patients with and without overt signs of heart failure after NSTEMI, and to determine which method has the best intra- and interobserver variability. Methods Population Patients were identified from a previously examined population of 371 low-risk NSTEMI patients who underwent gated, 64-slice MDCT coronary angiography to assess the clinical value of MDCT coronary angiography. In- and exclusion criteria have been described previously [9] In brief, patients had been included if they had NSTEMI and they were excluded if they had a contraindication to CT, such as history of chronic renal disease or plasma-creatinine >125 μmol/l, cardiac arrhythmia, known allergy to iodine contrast, hemodynamic instability, respiratory distress or pulmonary edema leading to inability to lie still in supine position. From this previously examined population we identified two subset groups of patients with either definite heart failure (cases) or no signs of heart failure (control).
Authors and Affiliations
Andreas Fabricius Bjerre, J Tobias Kühl, Preman Kumarathurai, Haseem Asraf, Klaus F Kofoed, Olav W Nielsen
Keywords
Related Articles
- EP ID EP594804
- DOI 10.26717/BJSTR.2019.15.002639
- Views 171
- Downloads 0
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