The use of computed tomography pulmonary angiography in the diagnosis of heart failure in the acute setting
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ORIGINAL ARTICLE
The use of computed tomography pulmonary angiography in the diagnosis of heart failure in the acute setting Liam O’Halloran 1 & Julie O’Brien 1 Received: 4 February 2020 / Accepted: 2 April 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Heart failure is a clinical diagnosis characterised by non-specific symptoms such as dyspnoea, fatigue and oedema. The aim of this pilot study was to investigate what role computed tomography pulmonary angiography could play in supporting a diagnosis of heart failure when a pulmonary embolism has been excluded. Methods This was a prospective study using the National Integrated Medical Imaging System to assess the potential of computed tomography pulomary angiography (CTPA) as a diagnostic test for heart failure. Consecutive patients were collected from three hospitals of the University of Limerick Hospital Group. We reviewed 230 consecutive CTPA results for cardiac and lung features. Of these, we confirmed which had heart failure by comparison with brain natriuretic peptide (BNP) and echocardiogram criteria. Exclusion criteria included any patients with a diagnosis of pulmonary embolism. Results Of these 230 patients, only 24 (10.4%) had both objective and clinical signs of heart failure. The most specific signs were shown to be left ventricular enlargement, left atrial enlargement and right ventricular enlargement, which approximated a specificity of 100% (CI 66.3–100.00%). CTPA was shown to match gold standard echocardiography closely in detecting abnormalities as per chi square; Right ventricular enlargement (value = 5.426 P = 0.02), left atrial enlargement (value = 4.9 P = 0.027) and left ventricular enlargement (value = 5.692 P = 0.017). Conclusion Findings on CTPA which included left ventricular enlargement, left atrial enlargement and right ventricular enlargement were shown to be specific for a diagnosis of heart failure. CTPA should be used by physicians awaiting echocardiography to help guide treatment in cases of suspected heart failure. Keywords Computed tomography . Heart failure . Pulmonary angiography
Introduction Heart failure is a clinical syndrome characterised by the following symptoms: dyspnoea at rest or on exercise, fatigue, tiredness and peripheral oedema in combination with signs typical of heart failure (tachypnoea, pulmonary crackles, tachycardia, pleural effusion, raised jugular venous pressure, oedema, hepatomegaly). To confirm a diagnosis of heart failure, there needs to be objective evidence of a structural abnormality of the heart at rest (such as an abnormality on the echocardiogram or a raised brain natriuretic peptide (BNP) concentration) as per European Society of Cardiology (ESC) guidelines [1]. However, it can be challenging
* Liam O’Halloran [email protected] 1
Department of Radiology, University Hospital Limerick, Dooradyle, Ireland
to obtain objective measures such as a brain natriuretic peptide (BNP) result or echocardiogram immediately in the acute setting. In our institutions, University Limerick
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