Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 8/2022

Open Access 10-03-2022 | Computed Tomography | Cardiac

Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease

Authors: Claudius Melzig, Thuy Duong Do, Benjamin Egenlauf, Sasan Partovi, Ekkehard Grünig, Hans-Ulrich Kauczor, Claus Peter Heussel, Fabian Rengier

Published in: European Radiology | Issue 8/2022

Login to get access

Abstract

Objectives

To assess diagnostic accuracy of automated 3D volumetry of cardiac chambers based on computed tomography pulmonary angiography (CTPA) for the differentiation of pulmonary hypertension due to left heart disease (group 2 PH) from non-group 2 PH compared to manual diameter measurements.

Methods

Patients with confirmed PH undergoing right heart catheterisation and CTPA within 100 days for diagnostic workup of PH between August 2013 and February 2016 were included in this retrospective, single-centre study. Automated 3D segmentation of left atrium, left ventricle, right atrium and right ventricle (LA/LV/RA/RV) was performed by two independent and blinded radiologists using commercial software. For comparison, axial diameters were manually measured. The ability to differentiate group 2 PH from non-group 2 PH was assessed by means of logistic regression.

Results

Ninety-one patients (median 67.5 years, 44 women) were included, thereof 19 patients (20.9%) classified as group 2 PH. After adjustment for age, sex and mean pulmonary arterial pressure, group 2 PH was significantly associated with larger LA volume (p < 0.001), larger LV volume (p = 0.001), lower RV/LV volume ratio (p = 0.04) and lower RV/LA volume ratio (p = 0.003). LA volume demonstrated the highest discriminatory ability to identify group 2 PH (AUC, 0.908; 95% confidence interval, 0.835–0.981) and was significantly superior to LA diameter (p = 0.009). Intraobserver and interobserver agreements were excellent for all volume measurements (intraclass correlation coefficients 0.926–0.999, all p < 0.001).

Conclusions

LA volume quantified by automated, CTPA-based 3D volumetry can differentiate group 2 PH from other PH groups with good diagnostic accuracy and yields significantly higher diagnostic accuracy than left atrial diameter.

Key Points

• Automated cardiac chamber volumetry using non-gated CT pulmonary angiography can differentiate pulmonary hypertension due to left heart disease from other causes with good diagnostic accuracy.
• Left atrial volume yields significantly higher diagnostic accuracy than left atrial axial diameter for identification of pulmonary hypertension due to left heart disease without time-consuming manual processing.
Appendix
Available only for authorised users
Literature
1.
Galiè N, Humbert M, Vachiery J-L et al (2015) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 37:67–119CrossRef
2.
Simonneau G, Gatzoulis MA, Adatia I et al (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 62:D34–D41CrossRef
3.
Vachiery J-L, Tedford RJ, Rosenkranz S et al (2019) Pulmonary hypertension due to left heart disease. Eur Respir J 53:1801897CrossRef
4.
Simonneau G, Montani D, Celermajer DS et al (2019) Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 53:1801913CrossRef
5.
Rosenkranz S, Gibbs JSR, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiery J-L (2016) Left ventricular heart failure and pulmonary hypertension. Eur Heart J 37:942–954CrossRef
6.
Wijeratne DT, Lajkosz K, Brogly SB et al (2018) Increasing incidence and prevalence of World Health Organization groups 1 to 4 pulmonary hypertension: a population-based cohort study in Ontario, Canada. Circ Cardiovasc Qual Outcomes 11:e003973CrossRef
7.
Currie BJ, Johns C, Chin M et al (2018) CT derived left atrial size identifies left heart disease in suspected pulmonary hypertension: derivation and validation of predictive thresholds. Int J Cardiol 260:172–177CrossRef
8.
Jivraj K, Bedayat A, Sung YK et al (2017) Left atrium maximal axial cross-sectional area is a specific computed tomographic imaging biomarker of World Health Organization group 2 pulmonary hypertension. J Thorac Imaging 32:121–126CrossRef
9.
Katikireddy CK, Singh M, Muhyieddeen K, Acharya T, Ambrose JA, Samim A (2016) Left atrial area and right ventricle dimensions in non-gated axial chest CT can differentiate pulmonary hypertension due to left heart disease from other causes. J Cardiovasc Comput Tomogr 10:246–250CrossRef
10.
Tsang TSM, Abhayaratna WP, Barnes ME et al (2006) Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 47:1018–1023CrossRef
11.
Ecabert O, Peters J, Schramm H et al (2008) Automatic model-based segmentation of the heart in CT images. IEEE Trans Med Imaging 27:1189–1201CrossRef
12.
Lorenz C, Berg JV (2006) A comprehensive shape model of the heart. Med Image Anal 10:657–670CrossRef
13.
Abadi S, Roguin A, Engel A, Lessick J (2010) Feasibility of automatic assessment of four-chamber cardiac function with MDCT: initial clinical application and validation. Eur J Radiol 74:175–181CrossRef
14.
Aviram G, Rozenbaum Z, Ziv-Baran T et al (2017) Identification of pulmonary hypertension caused by left-sided heart disease (World Health Organization group 2) based on cardiac chamber volumes derived from chest CT imaging. Chest 152:792–799CrossRef
15.
Crawley SF, Johnson MK, Dargie HJ, Peacock AJ (2013) LA volume by CMR distinguishes idiopathic from pulmonary hypertension due to HFpEF. JACC Cardiovasc Imaging 6:1120–1121CrossRef
16.
Du Bois D, Du Bois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17:863–871CrossRef
17.
Mao SS, Li D, Vembar M et al (2014) Model-based automatic segmentation algorithm accurately assesses the whole cardiac volumetric parameters in patients with cardiac CT angiography: a validation study for evaluating the accuracy of the Workstation software and establishing the reference values. Acad Radiol 21:639–647CrossRef
18.
Lu MT, Demehri S, Cai T et al (2012) Axial and reformatted four-chamber right ventricle–to–left ventricle diameter ratios on pulmonary CT angiography as predictors of death after acute pulmonary embolism. AJR Am J Roentgenol 198:1353–1360
19.
Lick AN, Danrad R, Smith DL, Lammi MR (2017) Left atrium measurements via computed tomography pulmonary angiogram as a predictor of diastolic dysfunction. J Comput Assist Tomogr 41:792–797CrossRef
20.
Eifer DA, Nguyen ET, Thavendiranathan P, Hanneman K (2018) Diagnostic accuracy of sex-specific chest CT measurements compared with cardiac MRI findings in the assessment of cardiac chamber enlargement. AJR Am J Roentgenol 211:993–999
21.
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRef
22.
Ho D, Imai K, King G, Stuart EA (2011) MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 42:1–28CrossRef
23.
Robin X, Turck N, Hainard A et al (2011) pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinforma 12:77–78CrossRef
24.
Bujang MA, Adnan TH (2016) Requirements for minimum sample size for sensitivity and specificity analysis. J Clin Diagn Res 10:YE01–YE06PubMedPubMedCentral
25.
Hussain N, Charalampopoulos A, Ramjug S et al (2016) Pulmonary hypertension in patients with heart failure and preserved ejection fraction: differential diagnosis and management. Pulm Circ 6:3–14CrossRef
26.
Arsanjani R, Flint N, Beigel R et al (2019) Comparison of accuracy of left atrial area and volume by two-dimensional trans-thoracic echocardiography versus computed tomography. Am J Cardiol 123:1180–1184CrossRef
27.
Stojanovska J, Cronin P, Patel S et al (2011) Reference normal absolute and indexed values from ECG-gated MDCT: left atrial volume, function, and diameter. AJR Am J Roentgenol 197:631–637
28.
Taina M, Rissanen V, Hedman M et al (2015) Diagnostic performance of left atrial diameter measurement in computed tomography to detect increased left atrial volume. In Vivo 29:487–491PubMed
29.
Mahabadi AA, Truong QA, Schlett CL et al (2010) Axial area and anteroposterior diameter as estimates of left atrial size using computed tomography of the chest: comparison with 3-dimensional volume. J Cardiovasc Comput Tomogr 4:49–54CrossRef
30.
Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRef
31.
Rengier F, Wörz S, Melzig C et al (2016) Automated 3D volumetry of the pulmonary arteries based on magnetic resonance angiography has potential for predicting pulmonary hypertension. PLoS One 11:e0162516CrossRef
32.
Melzig C, Wörz S, Egenlauf B et al (2019) Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol 29:6059–6068CrossRef
33.
Kontopodis N, Metaxa E, Papaharilaou Y, Georgakarakos E, Tsetis D, Ioannou CV (2014) Value of volume measurements in evaluating abdominal aortic aneurysms growth rate and need for surgical treatment. Eur J Radiol 83:1051–1056CrossRef
34.
Wittram C (2007) How I do it: CT pulmonary angiography. AJR Am J Roentgenol 188:1255–1261
Metadata
Title
Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease
Authors
Claudius Melzig
Thuy Duong Do
Benjamin Egenlauf
Sasan Partovi
Ekkehard Grünig
Hans-Ulrich Kauczor
Claus Peter Heussel
Fabian Rengier
Publication date
10-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08663-0

Other articles of this Issue 8/2022

European Radiology 8/2022 Go to the issue

Computed Tomography

A new scheme of global feature management improved the performance and stability of radiomics model: a study based on CT images of acute brainstem infarction

Cardiac

Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry)

Gastrointestinal

Fractal analysis improves tumour size measurement on computed tomography in pancreatic ductal adenocarcinoma: comparison with gross pathology and multi-parametric MRI

Cardiac

One-year outcomes of CCTA alone versus machine learning–based FFRCT for coronary artery disease: a single-center, prospective study

Cardiac

Automatic coronary plaque detection, classification, and stenosis grading using deep learning and radiomics on computed tomography angiography images: a multi-center multi-vendor study

Hepatobiliary-Pancreas

Do transition and hepatobiliary phase hypointensity improve LI-RADS categorization as an alternative washout: a systematic review and meta-analysis