Journal of Cardiovascular Computed Tomography最新文献

Background

Accurate assessment of the pulmonary valve can dictate clinical management of patients with right ventricular outflow tract (RVOT) anomalies. Comparisons with available normal reference values are essential for accurate evaluation. The aim of the study was to generate normative data for the pulmonary valve annulus and sino-tubular (ST) junction using CT measurements derived from a heterogeneous pediatric population and create z-scores useful for clinical practice.

Methods

Patients without heart disease who underwent cardiac CT between April 2014 and February 2021 ​at Children's Hospital Colorado were included. Minimum and maximum diameter (mm) and cross-sectional area (mm²) for the pulmonary valve annulus and ST junction were measured. Previously validated models were used to normalize the measurements and calculate z-scores. Each measurement was plotted against BSA, and z-score distributions were used as reference lines.

Results

Three-hundred-sixty-seven healthy patients with a mean age of 8.8 years (1–21), 56% male, and BSA of 1.1 ​m² (0.4–2.1) were analyzed. The Haycock formula was used to present data as predicted values for a given BSA and within equations relating each measurement to BSA. Predicted values and z-score boundaries for all measurements are graphically re-presented.

Conclusions

CT-derived normative data for the pulmonary valve annulus and ST junction is reported from a heterogenous cohort of healthy children.

In current clinical practice, qualitative or semi-quantitative measures are primarily used to report coronary artery disease on cardiac CT. With advancements in cardiac CT technology and automated post-processing tools, quantitative measures of coronary disease severity have become more broadly available. Quantitative coronary CT angiography has great potential value for clinical management of patients, but also for research. This document aims to provide definitions and standards for the performance and reporting of quantitative measures of coronary artery disease by cardiac CT.

Background

Cardiac computed tomography quantification of extracellular volume fraction (CT-ECV) is an emerging biomarker of myocardial fibrosis which has demonstrated high reproducibility, diagnostic and prognostic utility. However, there has been wide variation in the CT-ECV protocol in the literature and useful disease cut-offs are yet to be established. The objectives of this meta-analysis were to describe mean CT-ECV estimates and to estimate the effect of CT-ECV protocol parameters on between-study variation.

Methods

We conducted a meta-analysis of studies assessing CT-ECV in healthy and diseased participants. We used meta-analytic methods to pool estimates of CT-ECV and performed meta-regression to identify the contribution of protocol parameters to CT-ECV heterogeneity.

Results

Thirteen studies had a total of 248 healthy participants who underwent CT-ECV assessment. Studies of healthy participants had high variation in CT-ECV protocol parameters. The pooled estimate of CT-ECV in healthy participants was 27.6% (95%CI 25.7%–29.4%) with significant heterogeneity (I² ​= ​93%) compared to 50.2% (95%CI 46.2%–54.2%) in amyloidosis, 31.2% (28.5%–33.8%) in severe aortic stenosis and 36.9% (31.6%–42.3%) in non-ischaemic dilated cardiomyopathies. Meta-regression revealed that CT protocol parameters account for approximately 25% of the heterogeneity in CT-ECV estimates.

Conclusion

CT-ECV estimates for healthy individuals vary widely in the literature and there is significant overlap with estimates in cardiac disease. One quarter of this heterogeneity is explained by differences in CT-ECV protocol parameters. Standardization of CT-ECV protocols is necessary for widespread implementation of CT-ECV assessment for diagnosis and prognosis.