TY - JOUR

T1 - Clinical and prognostic correlates of pulmonary congestion in coronary computed tomography angiography data sets

AU - Kühl, J Tobias

AU - Kristensen, Thomas S

AU - Thomsen, Anna F

AU - Hindsø, Louise

AU - Hansen, Kristoffer L

AU - Nielsen, Olav W

AU - Kelbæk, Henning

AU - Kofoed, Klaus F

N1 - Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

PY - 2016

Y1 - 2016

N2 - 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.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".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)).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.

AB - 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.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".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)).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.

KW - Aged

KW - Chi-Square Distribution

KW - Computed Tomography Angiography

KW - Coronary Angiography

KW - Disease Progression

KW - Female

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multidetector Computed Tomography

KW - Multivariate Analysis

KW - Non-ST Elevated Myocardial Infarction

KW - Predictive Value of Tests

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Pulmonary Edema

KW - Reproducibility of Results

KW - Risk Factors

KW - Severity of Illness Index

KW - Stroke Volume

KW - Time Factors

KW - Ventricular Function, Left

KW - Journal Article

KW - Observational Study

U2 - 10.1016/j.jcct.2016.09.002

DO - 10.1016/j.jcct.2016.09.002

M3 - Journal article

C2 - 27717753

VL - 10

SP - 466

EP - 472

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

SN - 1934-5925

IS - 6

ER -