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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.
ABSTRACT
Objective
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).
Methods
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.
Results
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.
Conclusion
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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