Incremental prognostic value of left ventricular function analysis over non-invasive coronary angiography with multidetector computed tomography.
BACKGROUND
The purpose of this study was to determine the prognostic value of computed tomography coronary angiography (CTA)-derived left ventricular (LV) function analysis and to assess its incremental prognostic value over the detection of significant stenosis using CTA.


METHODS
In 728 patients (400 males, mean age 55 ± 12 years) with known or suspected CAD, the presence of significant stenosis (≥ 50% stenosis) and LV function were assessed using CTA. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), and LV ejection fraction (LVEF) were calculated. LV function was assessed as a continuous variable and using cutoff values (LVEDV > 215 mL, LVESV > 90 mL, LVEF < 49%). The following events were combined in a composite end-point: all-cause mortality, non-fatal myocardial infarction, and unstable angina pectoris requiring hospitalization.


RESULTS
On CTA, a significant stenosis was observed in 221 patients (30%). During follow-up [median 765 days, 25-75th percentile: 493-978] an event occurred in 45 patients (6.2%). After multivariate correction for clinical risk factors and CTA, LVEF < 49% and LVESV > 90 mL were independent predictors of events with an incremental prognostic value over clinical risk factors and CTA.


CONCLUSIONS
The present results suggest that LV function analysis provides independent and incremental prognostic information beyond anatomic assessment of CAD using CTA.
de Graaf
Fleur R
FR
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. f.r.de_graaf@lumc.nl
van Werkhoven
Jacob M
JM
van Velzen
Joëlla E
JE
Antoni
M Louisa
ML
Boogers
Mark J
MJ
Kroft
Lucia J
LJ
de Roos
Albert
A
Schalij
Martin J
MJ
Jukema
J Wouter
JW
van der Wall
Ernst E
EE
Schuijf
Joanne D
JD
Bax
Jeroen J
JJ
D000368:Aged; D003251:Constriction, Pathologic; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*