Identifying left ventricular dysfunction using prospective electrocardiogram-triggered coronary computed tomography angiography.

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.