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Clinical and prognostic correlates of pulmonary congestion in coronary computed tomography angiography data sets.
- Source :
-
Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2016 Nov - Dec; Vol. 10 (6), pp. 466-472. Date of Electronic Publication: 2016 Sep 15. - Publication Year :
- 2016
-
Abstract
- Background: Signs of pulmonary congestion obtained from cardiac computed tomography angiographic (coronary CTA) images have not previously been related to clinical congestion or outcome and the clinical value is, therefore, unknown. Our objective was to test the hypothesis that signs of pulmonary congestion predict clinical heart failure and adverse outcome in patients with myocardial infarction.<br />Methods: Coronary CTA was performed before invasive treatment in 400 prospectively included patients with non ST segment elevation myocardial infarction in an observational study. Using a previously described chest computed tomography evaluation algorithm, patients were classified as having "no congestion", "mild to moderate congestion" or "severe congestion".<br />Results: Using multivariate analyses, presence of pulmonary congestion on coronary CTA images was associated with age, female gender, left ventricular ejection fraction (LVEF) and left atrial size. The diagnostic accuracy for predicting clinical heart failure, defined as Killip class >1, was: sensitivity: 83%, specificity: 69%, positive predictive value: 25%, and negative predictive value: 97%. The median follow-up time was 50 months and the study end-point of death or hospitalization due to heart failure was reached in 68 (16%) patients. In a Cox proportional hazards model with adjustments for known risk factors and Killip class, the presence of "mild to moderate congestion" and "severe congestion" was independently associated with adverse outcome (Hazard ratio: 2.6 (95% CI:1.3-5.0) and 3.2 (1.3-7.5)).<br />Conclusion: Signs of pulmonary congestion on coronary CTA images are closely correlated to cardiac dysfunction, predict clinical heart failure, and provide prognostic value independent of LVEF and Killip class.<br /> (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Chi-Square Distribution
Disease Progression
Female
Heart Failure physiopathology
Heart Failure therapy
Hospitalization
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Non-ST Elevated Myocardial Infarction mortality
Non-ST Elevated Myocardial Infarction physiopathology
Non-ST Elevated Myocardial Infarction therapy
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Pulmonary Edema mortality
Pulmonary Edema physiopathology
Pulmonary Edema therapy
Reproducibility of Results
Risk Factors
Severity of Illness Index
Stroke Volume
Time Factors
Ventricular Function, Left
Computed Tomography Angiography
Coronary Angiography methods
Multidetector Computed Tomography
Non-ST Elevated Myocardial Infarction diagnostic imaging
Pulmonary Edema diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1876-861X
- Volume :
- 10
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular computed tomography
- Publication Type :
- Academic Journal
- Accession number :
- 27717753
- Full Text :
- https://doi.org/10.1016/j.jcct.2016.09.002