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European Radiology
Published in: European Radiology 8/2022

Open Access 16-03-2022 | Computed Tomography | Cardiac

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Authors: Ilaria Vittoria de Martini, Adrian Raoul Kobe, Christian Roeren, Robert Manka, André Euler, Dagmar I. Keller, Frank Ruschitzka, Hatem Alkadhi, Matthias Eberhard

Published in: European Radiology | Issue 8/2022

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Abstract

Objectives

To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients.

Methods

In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis.

Results

Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980–0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82–0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81–0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively.

Conclusion

In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF.

Key Points

• Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography.
• In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.
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Metadata
Title
Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy
Authors
Ilaria Vittoria de Martini
Adrian Raoul Kobe
Christian Roeren
Robert Manka
André Euler
Dagmar I. Keller
Frank Ruschitzka
Hatem Alkadhi
Matthias Eberhard
Publication date
16-03-2022
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/s00330-022-08676-9

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