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

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 MDV) and LV mass (LV Mass) 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 MDV (LV MDVi) and the LV MDV :LV Mass ratio on CCTA can identify patients with reduced LVEF. 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 MDVi and LV MDV :LV Mass. 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 ​%. The derivation cohort had a mean LV MDVi of 61.0 ​± ​13.7 ​mL/m² and LV MDV :LV Mass of 1.11 ​± ​0.24 ​mL/g. LV MDVi and LV MDV :LV Mass 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 LV MDVi and LV MDV :LV Mass increased with the severity of LVEF reduction. Sex-specific LV MDVi thresholds were 79 ​% and 80 ​% specific for identifying abnormal LVEF in females (LV MDVi ​≥ ​69.9 ​mL/m²) and males (LV MDVi ​≥ ​78.8 ​mL/m²), respectively. LV MDV :LV Mass thresholds had high specificity (87 ​%) in both females (LV MDVi :LV Mass ​≥ ​1.39 ​mL/g) and males (LV MDVi :LV Mass ​≥ ​1.30 ​mL/g). Our study provides reference thresholds for LV MDVi and LV MDV :LV Mass on prospectively ECG-triggered CCTA, which may identify patients who require further LV function assessment. [ABSTRACT FROM AUTHOR]