{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:16:48Z","timestamp":1768281408159,"version":"3.49.0"},"reference-count":34,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T00:00:00Z","timestamp":1594944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2016R1D1A1B03933022, NRF-2018R1C1B6005448"],"award-info":[{"award-number":["NRF-2016R1D1A1B03933022, NRF-2018R1C1B6005448"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Delayed-enhanced dual-energy computed tomography (DECT) can evaluate the extent and degree of myocardial fibrosis while coronary CT angiography (CCTA) is a widely accepted coronary artery evaluation method. We sought to describe the role of combined cardiac CT for the evaluation of underlying etiology in patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Sixty-three consecutive patients (31 men, 63 \u00b1 16 years) with newly diagnosed HFrEF were enrolled in this prospective study. Coronary artery disease and myocardial fibrosis were evaluated on CCTA and DECT, respectively, and the tentative underlying etiologies of heart failure (HF) were determined with combinations of findings from both CTs. Concordance between tentative etiologies from cardiac CT and final etiologies from clinical decisions within a 2-year follow-up was assessed. Eighteen patients were diagnosed with ischemic HF on initial cardiac CT, and the final diagnosis was not changed. Another 45 patients with nonischemic HF included tentative etiologies of dilated cardiomyopathy (n = 32, 71.1%), sarcoidosis or myocarditis (n = 8, 17.8%), amyloidosis (n = 2, 4.4%), noncompaction (n = 2, 4.4%) and arrhythmogenic right ventricular cardiomyopathy (n = 1, 2.2%). Five nonischemic HF patients showed different etiologies between initial cardiac CT and clinical decisions. The concordance between cardiac CT and clinical decisions was 92.1%. A high degree of concordance was achieved between tentative etiologies from cardiac CT and final diagnoses from clinical decisions. Combined cardiac CT is a feasible, safe and effective imaging tool for the initial evaluation of newly diagnosed HFrEF patients.<\/jats:p>","DOI":"10.3390\/jcm9072270","type":"journal-article","created":{"date-parts":[[2020,7,22]],"date-time":"2020-07-22T03:23:16Z","timestamp":1595388196000},"page":"2270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Role of Cardiac Computed Tomography for Etiology Evaluation of Newly Diagnosed Heart Failure with Reduced Ejection Fraction"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8139-5646","authenticated-orcid":false,"given":"Dong Jin","family":"Im","sequence":"first","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0998-503X","authenticated-orcid":false,"given":"Jong-Chan","family":"Youn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 16247, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4349-9174","authenticated-orcid":false,"given":"Hye-Jeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyungsun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Joo","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoo Jin","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Hur","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byoung Wook","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seok-Min","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (ESC)developed with the special contribution of the heart failure association (HFA) of the esc","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4070\/kcj.2016.0429","article-title":"Temporal trends of hospitalized patients with heart failure in Korea","volume":"47","author":"Youn","year":"2017","journal-title":"Korean Circ. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3904\/kjim.2018.428","article-title":"Update on heart failure management and future directions","volume":"34","author":"Choi","year":"2019","journal-title":"Korean J. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"25","DOI":"10.36628\/ijhf.2019.0004","article-title":"Common co-morbidities in heart failure\u2013diabetes, functional mitral regurgitation and sleep apnoea","volume":"1","year":"2019","journal-title":"Int. J. Heart Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1016\/j.jacc.2009.04.094","article-title":"The role of cardiovascular magnetic resonance imaging in heart failure","volume":"54","author":"Karamitsos","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.36628\/ijhf.2019.0002","article-title":"Focused update of 2016 Korean society of heart failure guidelines for the management of chronic heart failure","volume":"1","author":"Kim","year":"2019","journal-title":"Int. J. Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4070\/kcj.2018.0349","article-title":"KSHF guidelines for the management of acute heart failure: Part II. Treatment of acute heart failure","volume":"49","author":"Lee","year":"2019","journal-title":"Korean Circ. J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lee, H.Y., and Oh, B.H. (2020). Paradigm shifts of heart failure therapy: Do we need another paradigm?. Int. J. Heart Fail., 2.","DOI":"10.36628\/ijhf.2020.0010"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1056\/NEJMoa0806576","article-title":"Diagnostic performance of coronary angiography by 64-row CT","volume":"359","author":"Miller","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1161\/01.CIR.97.3.282","article-title":"Chronic heart failure in the United States: A manifestation of coronary artery disease","volume":"97","author":"Gheorghiade","year":"1998","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1016\/j.jacc.2013.02.005","article-title":"2013 ACCF\/ACR\/ASE\/ASNC\/SCCT\/SCMR appropriate utilization of cardiovascular imaging in heart failure: A joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Foundation appropriate use criteria task force","volume":"61","author":"Patel","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1161\/CIRCULATIONAHA.104.529511","article-title":"Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: Comparison with contrast-enhanced magnetic resonance","volume":"113","author":"Gerber","year":"2006","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1007\/s00330-012-2674-0","article-title":"Assessment of myocardial fibrosis and coronary arteries in hypertrophic cardiomyopathy using combined arterial and delayed enhanced CT: Comparison with MR and coronary angiography","volume":"23","author":"Zhao","year":"2013","journal-title":"Eur. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s10554-016-1024-8","article-title":"Assessment of myocardial delayed enhancement with cardiac computed tomography in cardiomyopathies: A prospective comparison with delayed enhancement cardiac magnetic resonance imaging","volume":"33","author":"Lee","year":"2017","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.jcct.2008.10.015","article-title":"Evaluation of myocardial viability by multidetector CT","volume":"3","author":"Mendoza","year":"2009","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s00330-014-3126-9","article-title":"Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction","volume":"24","author":"Wichmann","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1148\/radiol.2017162945","article-title":"Utility of dual-energy CT-based monochromatic imaging in the assessment of myocardial delayed enhancement in patients with cardiomyopathy","volume":"287","author":"Chang","year":"2018","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1148\/radiol.2018172523","article-title":"Myocardial delayed enhancement CT for the evaluation of heart failure: Comparison to MRI","volume":"288","author":"Ohta","year":"2018","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11886-011-0179-0","article-title":"The role of cardiac MR in new-onset heart failure","volume":"13","author":"Kim","year":"2011","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1148\/radiol.12112458","article-title":"Interstitial myocardial fibrosis assessed as extracellular volume fraction with low-radiation-dose cardiac CT","volume":"264","author":"Nacif","year":"2012","journal-title":"Radiology"},{"key":"ref_21","first-page":"240","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation\/American Heart Association task force on practice guidelines","volume":"128","author":"Yancy","year":"2013","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcct.2016.04.005","article-title":"Cad-rads(tm) coronary artery disease-reporting and data system. An expert consensus document of the society of cardiovascular computed tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology","volume":"10","author":"Cury","year":"2016","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1148\/rg.291085052","article-title":"A pattern-based approach to assessment of delayed enhancement in nonischemic cardiomyopathy at MR imaging","volume":"29","author":"Cummings","year":"2009","journal-title":"Radiographics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/S0735-1097(01)01738-7","article-title":"A standardized definition of ischemic cardiomyopathy for use in clinical research","volume":"39","author":"Felker","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1093\/eurheartj\/ehi258","article-title":"Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies","volume":"26","author":"Mahrholdt","year":"2005","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"532","DOI":"10.2214\/AJR.08.1608","article-title":"CT detection of subendocardial fat in myocardial infarction","volume":"192","author":"Ahn","year":"2009","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"519","DOI":"10.2214\/AJR.13.12326","article-title":"Left ventricular noncompaction: Imaging findings and diagnostic criteria","volume":"204","author":"Zuccarino","year":"2015","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jcct.2011.06.001","article-title":"SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT","volume":"5","author":"Halliburton","year":"2011","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.hrthm.2014.03.043","article-title":"HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis","volume":"11","author":"Birnie","year":"2014","journal-title":"Heart Rhythm"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1016\/j.jacc.2005.11.067","article-title":"Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias","volume":"47","author":"Pieroni","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1161\/CIRCULATIONAHA.108.840827","article-title":"Diagnosis of arrhythmogenic right ventricular cardiomyopathy\/dysplasia: Proposed modification of the task force criteria","volume":"121","author":"Marcus","year":"2010","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1016\/j.jacc.2014.08.035","article-title":"The relationship of left ventricular trabeculation to ventricular function and structure over a 9.5-year follow-up: The mesa study","volume":"64","author":"Zemrak","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.jacc.2016.05.060","article-title":"Underutilization of coronary artery disease testing among patients hospitalized with new-onset heart failure","volume":"68","author":"Doshi","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"46S","DOI":"10.2967\/jnumed.114.150441","article-title":"Cardiac CT angiography in congestive heart failure","volume":"56","author":"Levine","year":"2015","journal-title":"J. Nucl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/7\/2270\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:49:19Z","timestamp":1760176159000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/7\/2270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,17]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["jcm9072270"],"URL":"https:\/\/doi.org\/10.3390\/jcm9072270","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,17]]}}}