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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


Arsanjani, Reza; Berman, Daniel S; Gransar, Heidi; Cheng, Victor Y; Dunning, Allison; Lin, Fay Y; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J; Callister, Tracy Q; Chang, Hyuk-Jae; Cademartiri, Filippo; Chinnaiyan, Kavitha M; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp; LaBounty, Troy M; Leipsic, Jonathon; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Cury, Ricardo C; Feuchtner, Gudrun; Kim, Yong-Jin; Min, James K (2014). 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. Radiology:122816.

Abstract

Purpose 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. Materials and 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). Conclusion LV dysfunction and volumes measured with cardiac CT angiography augment risk prediction and discrimination for future mortality. © RSNA, 2014.

Abstract

Purpose 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. Materials and 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). Conclusion LV dysfunction and volumes measured with cardiac CT angiography augment risk prediction and discrimination for future mortality. © RSNA, 2014.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:4 July 2014
Deposited On:27 Aug 2014 17:13
Last Modified:08 Dec 2017 07:01
Publisher:Radiological Society of North America
ISSN:0033-8419
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1148/radiol.14122816
PubMed ID:24991988

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