MDCT Is Useful for Comprehensive Evaluation of Organic Heart Diseases in Patients With Heart Failure

Background: According to the ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR guidelines (Circulation 2010;122:e525–55), using cardiac CT to evaluate cardiac function in subjects with heart failure is appropriate only when insufficient data are acquired by transthoracic echocardiogram and cardiac magnetic resonance. Methods and Results: In addition to its utility for evaluating cardiac function, MDCT is useful for the comprehensive evaluation of organic heart diseases in patients with heart failure. MDCT can be used for assessing the coronary arteries and myocardium to determine shunt flow, abnormal anatomy, and their spatial relationships to other organs. To date, we have reported 16 cases where MDCT was used for suspected heart failure involving organic heart diseases. The cases included 1) supracardiac type 1a total anomalous pulmonary venous return with a right-to-left shunt atrial septal defect; 2) giant pulmonary trunk with Eisenmenger-flow through the patent ductus arteriosus; 3) massive myocardial aneurysm due to an inferior-to-posterior myocardial infarction complicated by right-sided heart failure; 4) idiopathic diverticulum-type enlargement of the right atrium; 5) double-outlet right ventricle; and 6) noncompaction-like remodeling of the right ventricle in a middle-aged subject with modified transposition of the great arteries. Furthermore, we present a three-dimensional CT strain analysis to evaluate left ventricular myocardial characteristics and function using existing volumetric CT data. Conclusion: Cardiac MDCT is useful for evaluating organic heart diseases in patients with heart failure.