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

J Tobias Kühl; Thomas S Kristensen; Anna F Thomsen; Louise Hindsø; Kristoffer L Hansen; Olav W Nielsen; Henning Kelbæk; Klaus F Kofoed

doi:10.1016/j.jcct.2016.09.002

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

J Tobias Kühl, Thomas S Kristensen, Anna F Thomsen, Louise Hindsø, Kristoffer L Hansen, Olav W Nielsen, Henning Kelbæk, Klaus F Kofoed

Department of Clinical Medicine

1 Citation (Scopus)

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.

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.

Original language	English
Journal	Journal of Cardiovascular Computed Tomography
Volume	10
Issue number	6
Pages (from-to)	466-472
Number of pages	7
ISSN	1934-5925
DOIs	https://doi.org/10.1016/j.jcct.2016.09.002
Publication status	Published - 1 Nov 2016

Keywords

Aged
Chi-Square Distribution
Computed Tomography Angiography
Coronary Angiography
Disease Progression
Female
Heart Failure
Hospitalization
Humans
Logistic Models
Male
Middle Aged
Multidetector Computed Tomography
Multivariate Analysis
Non-ST Elevated Myocardial Infarction
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Pulmonary Edema
Reproducibility of Results
Risk Factors
Severity of Illness Index
Stroke Volume
Time Factors
Ventricular Function, Left
Journal Article
Observational Study

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10.1016/j.jcct.2016.09.002

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@article{ea3acb3efd7c41adb4c36142e2b8186c,

title = "Clinical and prognostic correlates of pulmonary congestion in coronary computed tomography angiography data sets",

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.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.",

keywords = "Aged, Chi-Square Distribution, Computed Tomography Angiography, Coronary Angiography, Disease Progression, Female, Heart Failure, Hospitalization, Humans, Logistic Models, Male, Middle Aged, Multidetector Computed Tomography, Multivariate Analysis, Non-ST Elevated Myocardial Infarction, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Pulmonary Edema, Reproducibility of Results, Risk Factors, Severity of Illness Index, Stroke Volume, Time Factors, Ventricular Function, Left, Journal Article, Observational Study",

author = "K{\"u}hl, {J Tobias} and Kristensen, {Thomas S} and Thomsen, {Anna F} and Louise Hinds{\o} and Hansen, {Kristoffer L} and Nielsen, {Olav W} and Henning Kelb{\ae}k and Kofoed, {Klaus F}",

year = "2016",

month = nov,

day = "1",

doi = "10.1016/j.jcct.2016.09.002",

language = "English",

volume = "10",

pages = "466--472",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier",

number = "6",

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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

PY - 2016/11/1

Y1 - 2016/11/1

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

SN - 1934-5925

VL - 10

SP - 466

EP - 472

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

IS - 6

ER -

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

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Keywords

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