Prognostic significance of ejection fraction derived from prospectively ECG-triggered coronary CT angiography

Prospective electrocardiogram (ECG)-triggered coronary computed tomography (CT) angiography is widely used for noninvasive evaluation of coronary artery disease, with relatively low radiation exposure. However, its limited temporal sampling restricts comprehensive assessment of left ventricular (LV) systolic function. Therefore, novel functional parameters derived from restricted acquisition windows may provide additional prognostic information without increasing radiation dose.

To evaluate the prognostic significance of LVEF_120ms, a novel systolic functional parameter derived from LV volume change over a 120-ms systolic acquisition window.

This retrospective single-center study included 356 patients who underwent prospectively ECG-triggered coronary CT angiography between 2021 and 2023. We calculated LVEF_120ms from three systolic phases using semi-automated volumetric analysis. The primary endpoint was major adverse cardiovascular events (MACE). Receiver operating characteristic (ROC) analysis determined the optimal cut-off value, and Kaplan-Meier and Cox regression analyses were used to assess outcomes.

During a median follow-up of 36 months, 31 patients (8.7%) experienced MACE. Median LVEF_120ms was significantly lower in patients with MACE (5.6% vs. 10.2%, p < 0.001). The optimal cut-off was 7.2% (area under the ROC curve [AUC]: 0.712). Patients with LVEF_120ms ≤ 7.2% had significantly reduced MACE-free survival (p < 0.001). In multivariable analysis, LVEF_120ms ≤ 7.2% remained an independent predictor of MACE (hazard ratio [HR]: 3.42; p = 0.002).

The parameter LVEF_120ms derived from prospectively ECG-triggered cardiac CT independently predicts adverse cardiovascular events and may improve risk stratification without additional radiation.