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Identifying left ventricular dysfunction using prospective electrocardiogram-triggered coronary computed tomography
Ashwin Sharma1, Fernanda Erthal2, Daniel Juneau3
1Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada.
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 (LVMDV) and LV mass (LVMass) 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 LVMDV (LVMDVi) and the LVMDV:LVMass 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 LVMDVi and LVMDV:LVMass. 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 LVMDVi of 61.0 ± 13.7 mL/m2 and LVMDV:LVMass of 1.11 ± 0.24 mL/g. LVMDVi and LVMDV:LVMass were both higher in patients with reduced LVEF than those with normal LVEF (98.8 ± 40.8 mL/m2 vs. 63.3 ± 19.7 mL/m2, p < 0.001, and 1.32 ± 0.44 mL/g vs. 1.05 ± 0.28 mL/g, p < 0.001). Both mean LVMDVi and LVMDV:LVMass increased with the severity of LVEF reduction. Sex-specific LVMDVi thresholds were 79 % and 80 % specific for identifying abnormal LVEF in females (LVMDVi ≥ 69.9 mL/m2) and males (LVMDVi ≥ 78.8 mL/m2), respectively. LVMDV:LVMass thresholds had high specificity (87 %) in both females (LVMDVi:LVMass ≥ 1.39 mL/g) and males (LVMDVi:LVMass ≥ 1.30 mL/g).
Conclusion:
Our study provides reference thresholds for LVMDVi and LVMDV:LVMass on prospectively ECG-triggered CCTA, which may identify patients who require further LV function assessment.
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