Incremental prognostic value of left ventricular function analysis over non-invasive coronary angiography with multidetector computed tomography |
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Authors: | Fleur R. de Graaf MD Jacob M. van Werkhoven MSc Joëlla E. van Velzen MD M. Louisa Antoni MD Mark J. Boogers MD Lucia J. Kroft MD PhD Albert de Roos MD PhD Martin J. Schalij MD PhD J. Wouter Jukema MD PhD Ernst E. van der Wall MD PhD Joanne D. Schuijf PhD Jeroen J. Bax MD PhD |
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Affiliation: | 1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands 2. The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands 3. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract: | 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. |
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