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Objective:
To evaluate whether left ventricular ejection fraction (LVEF) on echocardiography (echo) affects CT postcontrast enhancement of pancreatic ductal adenocarcinoma (PDAC) and surrounding normal pancreas.

Materials and Methods:
35 subjects (19 females, age 70±10 years) with PDAC who underwent surgical resection (from 5/2008 to 11/2014) and had available presurgical multiphase postcontrast CT and echo were included in this retrospective cohort. LVEF was classified into binary abnormal (LVEF < = 55%) versus normal (LVEF > 55%) groups on echo. In general, weight-based iopamidol-370 (Bracco, Monroe Township, NJ) with standardized bolus tracking was used for multiphase exams. On presurgical noncontrast (Non), arterial (Art), and venous (Ven) phase CT, single axial image regions of interest (ROI) were placed over the center of the pancreatic tumor and adjacent presumed normal pancreas. Mean Hounsfield units (HU) were recorded on each contrast phase CT. HU values for LVEF based groups were compared using the Mann Whitney U test. Categorical variables were compared via Chi square test.

Results:
The LVEF < = 55% group had significantly lower HU values for Tumor HU Art (p < 0.01) and Ven (p = 0.03) as well as subtraction Art-Non (p<0.01) and Ven-Non (p=0.01). Adjacent presumed normal pancreas also had lower HU Ven (p = 0.01). Tumor HU Non was not significantly different between LVEF groups. Tumor size was also not significantly different and tumor histology differentiation was predominantly moderate/poor differentiation.

Conclusion:
Abnormal LVEF may affect CT tumor and pancreas parenchymal enhancement in patients with PDAC, which may significantly influence quantitative HU measures of PDAC including radiomics work. Future larger studies may be helpful in defining the degree that abnormal cardiovascular function can affect tumor and pancreas parenchymal enhancement.