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Clin Exp Emerg Med > Accepted Articles
doi: https://doi.org/10.15441/ceem.24.194    [Accepted]
Can left atrial diameter measured by computed tomography predict the presence and degree of left ventricular diastolic dysfunction?
Gae An Kim , Ji Ung Na , Dong Hyuk Shin , Jang Hee Lee
Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence  Jang Hee Lee Tel: +82-2-2001-2488, Fax: +82-2-2001-2891, Email: lemonpianote@gmail.com
Received: January 24, 2024. Revised: April 15, 2024.  Accepted: April 19, 2024. Published online: May 23, 2024.
This study was conducted to determine whether the presence and degree of left ventricular diastolic dysfunction (LVDD) can be predicted by the simple computed tomography (CT)-measured left atrial diameter (CTLAD).
Among adult patients who underwent both chest CT imaging and echocardiography in the emergency department from January 2020 to December 2021, a retrospective cross-sectional study enrolled patients in whom the time interval between the two tests was <24 hours. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of CTLAD for echocardiographic LVDD.
In a study involving 373 patients, 192 (51.5%) had LVDD. Among them, 122 (63.5%) had grade 1, 61 (31.8%) had grade 2, and nine (4.7%) had ≥grade 3. Median CTLAD values were 4.1 cm for grade 1, 4.5 cm for grade 2, and 4.9 cm for ≥grade 3. The area under the ROC curve value of CTLAD in distinguishing ≥grade 1, ≥grade 2 (optimal cutoff ≥4.4 cm), and ≥grade 3 (optimal cutoff ≥4.5 cm) were 0.588, 0.657 (sensitivity, 61.4%; specificity, 66.0%, positive predictive value, 29.5%; negative predictive value, 88.1%; odds ratio, 3.1), and 0.834 (sensitivity, 88.9%; specificity, 70.1%; positive predictive value, 6.8%; negative predictive value, 99.6%, odds ratio, 18.7), respectively.
CTLAD ≥4.4 cm can be used as a rough reference value to distinguish LVDD of ≥grade 2, while CTLAD ≥4.5 cm can very reliably distinguish LVDD of ≥grade 3. CTLAD might be a very useful parameter for predicting LVDD in situations where echocardiography is not available.
Keywords: Computed tomography; Echocardiography; Diastolic heart failure; Left ventricular dysfunction; Left atrium
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