Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation

Abstract

Purpose: The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI).

Materials and Methods: 224 patients (64 ± 10 years; male 63 %) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as “significant” if they were recommended to additional diagnostics or therapy, and otherwise as “non-significant”. Additionally, cardiac findings were documented in detail.

Results: A total of 724 cardiac findings were identified in 203 patients (91 % of patients). Additionally, a total of 619 extra-cardiac findings were identified in 179 patients (80 % of patients). Among these extra-cardiac findings 196 (32 %) were “significant”, and 423 (68 %) were “non-significant”. In 2 patients (1 %) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the “significant” findings (124 additional CT, costs 38 314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p <0.05).

Conclusion: Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient.

Key points:

• Cardiac and extra-cardiac findings are common in patients with an indication for pulmonary vein isolation on previous CT scans.

• Malignancies can be detected in 1 % of all patients.

• 32 % of all extra-cardiac findings can be of significant relevance with consequences for patients.

• Altogether, there are 3.2 cardiac and 2.8 extra-cardiac findings in patients with indication for pulmonary vein isolation and CT.

• Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p <0.05).

Citation Format:

• Sohns JM, Menke J, Staab W et al. Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation. Fortschr Röntgenstr 2014; 186: 860 – 867

Zusammenfassung

Ziele: In dieser Studie wurde bei Patienten mit Vorhofflimmern die Inzidenz von kardialen und signifikanten extra-kardialen Befunden im CT vor Pulmonalvenen-Isolation untersucht.

Material und Methoden: 224 Patienten (64 ± 10 Jahre; männlich 63 %) mit Vorhofflimmern wurden vor PVI mit einer kardialen 64-Zeilen CT untersucht. Extra-kardiale Befunde wurden als „signifikant“ bezeichnet, wenn zusätzliche Untersuchungen oder Therapien empfohlen wurden; andernfalls wurden sie als „nicht signifikant“ bezeichnet. Die kardialen Befunde wurden ebenfalls ausgewertet. Die Befunde waren dem analysierenden Kardiologen und Radiologen vor dem CT unbekannt. Zusätzlich wurden Kosten für anschließende Bildgebungen ausgewertet, die zur Verifikation von möglichen pathologischen Befunden erforderlich waren.

Ergebnisse: Insgesamt wurden 724 kardiale Befunde bei 203 Patienten detektiert (91 % der Patienten). Zusätzlich wurden 619 extra-kardiale Befunde in 179 Patienten gefunden (80 % der Patienten). Bei diesen extra-kardialen Befunden waren 196 (32 %) „signifikant“ und 423 (68 %) „nicht signifikant“. Bei 2 Patienten (1 %) zeigten sich maligne Befunde, die vorher nicht bekannt waren (Ösophaguskarzinom und Bronchialkarzinom). 203 weiterführende bildgebende Untersuchungen folgten den primär detektierten Befunden im ersten CT, um die signifikanten extra-kardialen Befunde zu verifizieren (124 zusätzliche CT, Kosten 38 314,69 US Dollar). Insgesamt kamen auf einen untersuchten Patienten 3,2 kardiale und 2,8 extra-kardiale Befunde. Extra-kardiale Befunde kamen signifikant häufiger vor bei Patienten über 60 Jahren, Rauchern und Patienten mit einem kardialen pathologischen Befund (p < 0,05).

Schlussfolgerungen: Kardiale CT Untersuchungen vor Pulmonalvenen-Isolation sollten auf extra-kardiale Nebenbefunde untersucht werden, da diese für die Patienten relevant sein können, wie beispielweise die Detektion von Malignomen.

Kernaussagen:

• Kardiale und extra-kardiale Befunde treten bei Patienten mit der Indikation zur Pulmonalvenen-Isolation relativ häufig auf.

• Bei 2 Patienten (1 %) zeigten sich maligne Befunde, die vorher nicht bekannt waren (Ösophaguskarzinom und Bronchialkarzinom ohne Metastasierung).

• Unter den extra-kardialen Befunden fanden sich 196 (32 %) die als „signifikant“ bezeichnet wurden und die teils für die Patienten klinisch relevant waren.

Key words

cardiac - CT angiography - angiography - thorax - mediastinum - cost-effectiveness

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