Purpose: Coronary computed tomography angiography (CCTA) is an important non-invasive tool for the assessment of coronary artery disease and the delivery of information incremental to coronary anatomy. CCTA measured left ventricular (LV) mid-diastolic volume (LV) and LV mass (LV) have important prognostic information but the utility of prospectively ECG-triggered CCTA to predict reduced left ventricular ejection fraction (LVEF) is unknown. The objective of this study was to determine if indexed LV (LV) and the LV:LV ratio on CCTA can identify patients with reduced LVEF.
Materials/methods: 8179 patients with prospectively ECG-triggered CCTA between November 2014 and December 2019 were reviewed. A subset derivation cohort of 4352 healthy patients was used to define normal LV and LV:LV. Sex-specific thresholds were tested in a validation cohort of 1783 patients, excluded from the derivation cohort, with cardiac disease and known LVEF. The operating characteristics for 1 SD above the mean were tested for the identification of abnormal LVEF, LVEF≤35 % and ≤30 %.
Results: The derivation cohort had a mean LV of 61.0 ± 13.7 mL/m and LV:LV of 1.11 ± 0.24 mL/g. LV and LV:LV were both higher in patients with reduced LVEF than those with normal LVEF (98.8 ± 40.8 mL/m vs. 63.3 ± 19.7 mL/m, p < 0.001, and 1.32 ± 0.44 mL/g vs. 1.05 ± 0.28 mL/g, p < 0.001). Both mean LV and LV:LV increased with the severity of LVEF reduction. Sex-specific LV thresholds were 79 % and 80 % specific for identifying abnormal LVEF in females (LV ≥ 69.9 mL/m) and males (LV ≥ 78.8 mL/m), respectively. LV:LV thresholds had high specificity (87 %) in both females (LV:LV ≥ 1.39 mL/g) and males (LV:LV ≥ 1.30 mL/g).
Conclusion: Our study provides reference thresholds for LV and LV:LV on prospectively ECG-triggered CCTA, which may identify patients who require further LV function assessment.
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http://dx.doi.org/10.1016/j.jcct.2024.01.009 | DOI Listing |
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