What is the role of cardiac CT scanning in the workup of dilated cardiomyopathy?

Updated: Mar 02, 2021
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Cardiac CT scanning with angiography (CTA) can be used in the workup of undifferentiated heart failure. Biventricular volume and ejection fraction can be calculated with good correlation to echocardiography. With cine-loop formatting, regional wall motion can be assessed, with the highest accuracy for wall motion subtended by the left anterior descending and left circumflex arteries. [83]

In the assessment of ischemic cardiomyopathy, an Agatston coronary calcium score (CAC) of 0 has 100% specificity in excluding high-risk coronary artery disease (ie, the left main coronary artery, or stenosis of at least 2 major epicardial vessels). [84, 85]  Cardiac CTA has a 98% diagnostic sensitivity and 97% specificity for excluding ischemic cardiomyopathy. [86]

Myocardial perfusion analysis of the coronary arteries is also feasible; however, it has yet to mature to the level of diagnostic accuracy of cardiac MRI.

Finally, anatomic features specific to an inciting disease can be differentiated on CTA, such as infiltrative diseases (heterogeneous attenuation of myocardium), the location of hypertrophic cardiomyopathy, left ventricular noncompaction, arrhythmogenic right ventricular dysplasia, and congenital malformations. [85]

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