title: Left ventricular function and volume with coronary CT angiography improves risk stratification and identification of patients at risk for incident mortality: results from 7758 patients in the prospective multinational CONFIRM observational cohort study.
abstract: OBJECTIVE
  To assess whether gradations of left ventricular (LV) ejection fraction (LVEF) and volumes measured with coronary computed tomography (CT) would augment risk stratification and discrimination for incident mortality.
  
  
  METHODS
  This study was approved by the institutional review board, and informed consent was obtained when required. Subjects without known coronary artery disease (CAD) who underwent cardiac CT angiography with quantitative LV measurements were categorized according to LVEF (≥ 55%, 45%-54.9%, 35%-44.9%, or <35%). LV end-systolic volume (LVESV) and LV end-diastolic volume (LVEDV) were classified as normal (≥ 90 mL) or abnormal (≥ 200 mL). CAD extent and severity was categorized as none, nonobstructive, obstructive (≥ 50%), one-vessel, two-vessel, and three-vessel or left main disease. LVEF and volumes were assessed for risk prediction and discrimination of future mortality by using Cox hazards model and receiver operating characteristic curve analysis, respectively.
  
  
  RESULTS
  During a follow-up of 2.0 years ± 0.9, 7758 patients (mean age, 58.5 years ± 13.0; 4220 male patients [54.4%]) were studied. At multivariable analysis, worsening LVEF was independently associated with mortality for moderately (hazard ratio = 3.14, P < .001) and severely (hazard ratio = 5.19, P < .001) abnormal ejection fraction. LVEF demonstrated improved discrimination for mortality (Az = 0.816) when compared with CAD risk factors alone (Az = 0.781) or CAD risk factors plus extent and severity. At multivariable analysis of a subgroup of 3706 individuals, abnormal LVEDV (hazard ratio = 4.02) and LVESV (hazard ratio = 6.46) helped predict mortality (P < .001). Similarly, LVESV and LVEDV demonstrated improved discrimination when compared with CAD risk factors or CAD extent and severity (P < .05).
  
  
  CONCLUSIONS
  LV dysfunction and volumes measured with cardiac CT angiography augment risk prediction and discrimination for future mortality.
authors.affiliation: From Cedars-Sinai Heart Institute, Cardiac Image Research, Los Angeles, Calif (J.K.M.) and the CONFIRM Investigators. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (R.A., D.S.B., H.G.); Department of Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, Calif (T.L., J.K.M.); Weill Cornell Medical College and the New York Presbyterian Hospital and Weill Cornell Medical College, 515 E 70th St, S402, New York, NY 10021 (F.Y.L., J.K.M., A.D.); Department of Cardiology, University of Erlangen, Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Mich (M.A.); Department of Medicine, Harbor UCLA Medical Center, Los Angeles, Calif (M.J.B.); Tennessee Heart and Vascular Institute, Hendersonville, Tenn (T.Q.C.); Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Korea (H.J.C.); Department of Radiology, University Hospital of Parma, Parma, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oaks, Mich (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ottawa, Ont, Canada (B.J.W.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Cardiac Imaging, University Hospital, Zurich, Switzerland (P.K.); Department of Medicine, Emory University School of Medicine, Atlanta, Ga (L.J.S.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.V.); Department of Cardiovascular CT, Oklahoma Heart Institute, Tulsa, Okla (V.Y.C.); Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, Fla (R.C.C.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); and Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canad
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mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*