Abstract 18577: Evaluation of Right Ventricular Function using Cardiac Computed Tomography in Patients with Left Ventricular Assist Devices
Background: Right ventricular (RV) failure is a major contributor of morbidity and mortality after left ventricular assist device (LVAD) implantation. Accurate evaluation of RV function under LVAD support using echocardiography remains challenging.
Hypothesis: The feasibility and reproducibility of RV evaluation in patients with LVAD with electrocardiographic-gated cardiac computed tomography (CCT) is higher compared to echocardiography.
Methods: Twenty-five consecutive patients with an implanted LVAD underwent 2D-echocardiography and contrast-enhanced CCT with retrospective electrocardiographic gating. RV fractional area change, tricuspid annular plane systolic excursion (TAPSE) and RV end-diastolic short-to-long axis ratio were calculated by echocardiography. RV end-diastolic and end-systolic volumes and ejection fraction were quantified with CCT. Intraclass correlation coefficients (ICC) and Bland and Altman analysis were used to assess intra and inter-observer reproducibility for measurements.
Results: CCT studies were successfully performed in all patients with good image quality in 24 (96%). Intra-observer reproducibility for RV ejection fraction with CCT was excellent (ICC= 0.99; 95%CI 0.97–1.00). Inter-observer reproducibility for RV ejection fraction with CCT was also high whereas echocardiographic indices of RV function and geometry had lower reproducibility (Table). Mean inter-observer bias for RV ejection fraction with CCT was 0.77% (limits of agreement −6.87 and 8.41%) The echocardiographic index that best correlated with CCT determined RV ejection fraction was RV fractional area change (r=0.67; p=0.009).
Conclusions: CCT is feasible for the evaluation of RV function in patients with LVAD support. It has higher reproducibility than echocardiography and, therefore, should be considered as a first line imaging modality in this setting.
- © 2010 by American Heart Association, Inc.