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. 2024 Dec;11(4):358-364.
doi: 10.15441/ceem.24.194. Epub 2024 May 23.

Can left atrial diameter measured by computed tomography predict the presence and degree of left ventricular diastolic dysfunction?

Gae An Kim  1 , Ji Ung Na  1 , Dong Hyuk Shin  1 , Jang Hee Lee  1
Affiliations

Can left atrial diameter measured by computed tomography predict the presence and degree of left ventricular diastolic dysfunction?

Gae An Kim et al. Clin Exp Emerg Med. 2024 Dec.

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 -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 reliably distinguish LVDD of ≥grade 3. CTLAD might be a useful parameter for predicting LVDD in situations where echocardiography is not available.

Keywords: Computed tomography; Diastolic heart failure; Echocardiography; Left atrium; Left ventricular dysfunction.

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Conflict of interest statement

Conflicts of interest

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Measuring left atrium diameter on computed tomography. The anteroposterior diameter of the left atrium was assessed using the built-in measurement tool (red line) of the picture archiving and communication system.
Fig. 2.
Fig. 2.
Flowchart of the study. ED, emergency department; CT, computed tomography.
Fig. 3.
Fig. 3.
A scatterplot showing the relationship between computed tomography (CT)- and echocardiography-measured left atrium diameter (LAD).
Fig. 4.
Fig. 4.
A box plot of computed tomography–measured LA diameter (CTLAD) according to the grade of left ventricle diastolic dysfunction (LVDD). The displayed P-values are the results of a grade comparison performed using Dunn test.
Fig. 5.
Fig. 5.
Receiver operating characteristic (ROC) curve analysis of computed tomography–measured left atrium diameter (CTLAD) for distinguishing left ventricular diastolic dysfunction (LVDD). (A) LVDD grade 1. (B) LVDD grade 2. (C) LVDD ≥grade 3. AUC, area under the ROC curve; CTLADadj, CTLAD adjusted for left ventricular ejection fraction; AUCadj, AUC adjusted for left ventricular ejection fraction.
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