The estimation of left ventricular function using prospective ECG-triggered coronary CT angiography

Abstract

Background: Coronary computed tomography angiography (CCTA) is vital for diagnosing coronary artery disease; however, prospective ECG-triggered acquisition, minimizing radiation exposure, limits left ventricular (LV) ejection fraction (EF) evaluation. We aimed to assess the feasibility and utility of LVEF_100msec, a new index for estimating LV function using volumetric changes during 100 msec within systole.

Methods: This retrospective study analyzed patients who underwent prospective ECG-triggered CCTA with systolic acquisition between January 2015 and June 2022. The LVEF_100msec was calculated using the maximum and minimum LV volumes among the three phases (300, 350, and 400 msec post-QRS) and expressed as a percentage. Patients were classified into normal, mild-moderately reduced, or severely reduced LV function categories based on the reference test. The LVEF_100msec was compared among groups, and the optimal cutoff value of LVEF_100msec for predicting severe LV dysfunction was investigated.

Results: The study included 271 patients (median age ​= ​58 years, 52% male). LVEF was normal in 188 (69.4%), mild-moderately reduced in 57 (21.0%), and severely reduced in 26 (9.6%) patients. Median LVEF_100msec value was 9.0 (6.7-12.6) for normal LV function, 4.7 (3.1-8.8) for mild-moderately reduced, and 2.9 (1.5-3.8) for severely reduced LV function. LVEF_100msec values significantly differed among categories (p ​< ​0.001). The optimal LVEF_100msec cutoff for severe LV dysfunction was 4.3%, with an AUC of 0.924, sensitivity of 88%, and specificity of 89%.

Conclusion: The LVEF_100msec may serve as a valuable indicator of severe LV dysfunction.

Keywords: Coronary computed tomography angiography; Left ventricular dysfunction; Left ventricular ejection fraction; Retrospective study; Systolic acquisition.