Clinical utility of systolic left ventricular ejection fraction in atrial fibrillation: Role of prospective ECG-triggered cardiac CT.

BACKGROUND

The assessment of left ventricular (LV) systolic function and quantification of LV ejection fraction (LVEF) in patients with atrial fibrillation (AF) can be difficult. We previously demonstrated that LV volume changes over the 100 ms of systole (LVEF) can be used as a measure of LV systolic function.

OBJECTIVE

We sought to evaluate the applicability of LVEF in patients with AF.

METHODS

We screened patients with AF who underwent prospective systolic electrocardiogram-triggered cardiac computed tomography from January 2015 to June 2023. The correlation between LVEF and echocardiography-derived LVEF was assessed. Patients were categorized into 3 groups on the basis of echocardiographic LVEF (≤40%, 40%-55%, and ≥55%), and LVEF was compared among these groups. Receiver operating characteristic curve analysis and Cox proportional hazards models were used to determine the optimal LVEF cutoff for predicting LVEF ≤ 40% and major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure hospitalization, and stroke.

RESULTS

Of the total 123 patients, 62 (50.4%) had an LVEF of ≥55%, 40 (32.5%) had an LVEF of 40%-50%, and 21 (17.1%) had an LVEF of ≤40%. LVEF correlated with echocardiography-derived LVEF (P < .001) and differed significantly among groups (P < .001). LVEF ≤ 3.3% predicted LVEF ≤ 40% (area under the curve 0.809; sensitivity 87%; specificity 67%). Patients with an LVEF of ≤3.3% had a higher rate of MACE than did those without (P = .030), and LVEF ≤ 3.3% was an independent predictor of MACE.

CONCLUSION

LVEF can provide a useful indicator of LV dysfunction in patients with AF undergoing prospective electrocardiogram-triggered cardiac computed tomography.