Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT

Sanjay Doddamani, Michael J. Grushko, Amgad N. Makaryus, Vineet R. Jain, Ricardo Bello, Mark A. Friedman, Robert J Ostfeld, Divya Malhotra, Lawrence M. Boxt, Linda B. Haramati, Daniel M. Spevack

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background: Newer three-dimensional imaging technologies provide insight into cardiac shape and geometry from views previously unobtainable. Standard formulae like the continuity equation (CE) that rely on inherent assumptions about left ventricular outflow tract (LVOT) shape may need to be revisited. In the CE, small changes in LVOT diameter may significantly change calculated aortic valve area (AVA). Using 64-slice Multi-detector CT (MDCT), we performed LVOT planimetry to obviate the need for any geometric assumptions. Methods: 64-slice MDCT was performed in 30 consecutive patients. The diameter-derived LVOT area (ALVOTdiam) was calculated from a view analogous to the 2D echo parasternal long axis. Direct planimetry of the LVOT (ALVOTplan) was performed just beneath the aortic valve in a plane perpendicular to the LVOT long axis. Further, assuming an ellipsoid outflow tract shape, LVOT area (ALVOTellip) was calculated using πab from the long and short diameters of the planimetered LVOT view. Eccentricity index (EI) was estimated by subtracting the ratio of shortest and longest LVOT diameters from one. Results: ALVOTdiam always measured smaller than ALVOTplan (mean 3.7 ± 1.2 cm2 vs. 4.1 ± 1.3 cm2, respectively). The median EI was 0.18 (95% CI = 0.16-0.2; P = 0.0001). ALVOTellip more closely agreed with ALVOTplan (correlation = 0.96; P < 0.0001) than did ALVOTdiam (correlation = 0.87; P < 0.0001). Conclusion: Using MDCT, the LVOT was shown to be elliptical in most patients. Applying the CE which assumes roundness of the LVOT consistently underestimated the LVOT area which may affect estimated AVA. Planimetry of the LVOT utilizing three-dimensional imaging modalities such as 3-D echocardiography, MRI, or MDCT may render a more precise AVA.

Original languageEnglish (US)
Pages (from-to)175-181
Number of pages7
JournalInternational Journal of Cardiovascular Imaging
Volume25
Issue number2
DOIs
StatePublished - 2009

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Aortic Valve
Three-Dimensional Imaging
Three-Dimensional Echocardiography
Technology

Keywords

  • Continuity equation
  • Echocardiography
  • Left ventricular outflow tract
  • Multi-detector CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT. / Doddamani, Sanjay; Grushko, Michael J.; Makaryus, Amgad N.; Jain, Vineet R.; Bello, Ricardo; Friedman, Mark A.; Ostfeld, Robert J; Malhotra, Divya; Boxt, Lawrence M.; Haramati, Linda B.; Spevack, Daniel M.

In: International Journal of Cardiovascular Imaging, Vol. 25, No. 2, 2009, p. 175-181.

Research output: Contribution to journalArticle

Doddamani, Sanjay ; Grushko, Michael J. ; Makaryus, Amgad N. ; Jain, Vineet R. ; Bello, Ricardo ; Friedman, Mark A. ; Ostfeld, Robert J ; Malhotra, Divya ; Boxt, Lawrence M. ; Haramati, Linda B. ; Spevack, Daniel M. / Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT. In: International Journal of Cardiovascular Imaging. 2009 ; Vol. 25, No. 2. pp. 175-181.
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abstract = "Background: Newer three-dimensional imaging technologies provide insight into cardiac shape and geometry from views previously unobtainable. Standard formulae like the continuity equation (CE) that rely on inherent assumptions about left ventricular outflow tract (LVOT) shape may need to be revisited. In the CE, small changes in LVOT diameter may significantly change calculated aortic valve area (AVA). Using 64-slice Multi-detector CT (MDCT), we performed LVOT planimetry to obviate the need for any geometric assumptions. Methods: 64-slice MDCT was performed in 30 consecutive patients. The diameter-derived LVOT area (ALVOTdiam) was calculated from a view analogous to the 2D echo parasternal long axis. Direct planimetry of the LVOT (ALVOTplan) was performed just beneath the aortic valve in a plane perpendicular to the LVOT long axis. Further, assuming an ellipsoid outflow tract shape, LVOT area (ALVOTellip) was calculated using πab from the long and short diameters of the planimetered LVOT view. Eccentricity index (EI) was estimated by subtracting the ratio of shortest and longest LVOT diameters from one. Results: ALVOTdiam always measured smaller than ALVOTplan (mean 3.7 ± 1.2 cm2 vs. 4.1 ± 1.3 cm2, respectively). The median EI was 0.18 (95{\%} CI = 0.16-0.2; P = 0.0001). ALVOTellip more closely agreed with ALVOTplan (correlation = 0.96; P < 0.0001) than did ALVOTdiam (correlation = 0.87; P < 0.0001). Conclusion: Using MDCT, the LVOT was shown to be elliptical in most patients. Applying the CE which assumes roundness of the LVOT consistently underestimated the LVOT area which may affect estimated AVA. Planimetry of the LVOT utilizing three-dimensional imaging modalities such as 3-D echocardiography, MRI, or MDCT may render a more precise AVA.",
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AU - Doddamani, Sanjay

AU - Grushko, Michael J.

AU - Makaryus, Amgad N.

AU - Jain, Vineet R.

AU - Bello, Ricardo

AU - Friedman, Mark A.

AU - Ostfeld, Robert J

AU - Malhotra, Divya

AU - Boxt, Lawrence M.

AU - Haramati, Linda B.

AU - Spevack, Daniel M.

PY - 2009

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N2 - Background: Newer three-dimensional imaging technologies provide insight into cardiac shape and geometry from views previously unobtainable. Standard formulae like the continuity equation (CE) that rely on inherent assumptions about left ventricular outflow tract (LVOT) shape may need to be revisited. In the CE, small changes in LVOT diameter may significantly change calculated aortic valve area (AVA). Using 64-slice Multi-detector CT (MDCT), we performed LVOT planimetry to obviate the need for any geometric assumptions. Methods: 64-slice MDCT was performed in 30 consecutive patients. The diameter-derived LVOT area (ALVOTdiam) was calculated from a view analogous to the 2D echo parasternal long axis. Direct planimetry of the LVOT (ALVOTplan) was performed just beneath the aortic valve in a plane perpendicular to the LVOT long axis. Further, assuming an ellipsoid outflow tract shape, LVOT area (ALVOTellip) was calculated using πab from the long and short diameters of the planimetered LVOT view. Eccentricity index (EI) was estimated by subtracting the ratio of shortest and longest LVOT diameters from one. Results: ALVOTdiam always measured smaller than ALVOTplan (mean 3.7 ± 1.2 cm2 vs. 4.1 ± 1.3 cm2, respectively). The median EI was 0.18 (95% CI = 0.16-0.2; P = 0.0001). ALVOTellip more closely agreed with ALVOTplan (correlation = 0.96; P < 0.0001) than did ALVOTdiam (correlation = 0.87; P < 0.0001). Conclusion: Using MDCT, the LVOT was shown to be elliptical in most patients. Applying the CE which assumes roundness of the LVOT consistently underestimated the LVOT area which may affect estimated AVA. Planimetry of the LVOT utilizing three-dimensional imaging modalities such as 3-D echocardiography, MRI, or MDCT may render a more precise AVA.

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