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

For the CONFIRM Investigators

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

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.

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.

Original languageEnglish
Pages (from-to)70-77
Number of pages8
JournalRadiology
Volume273
Issue number1
DOIs
Publication statusPublished - 2014 Oct 1

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Coronary Angiography
Left Ventricular Function
Proportional Hazards Models
Observational Studies
Cohort Studies
Mortality
ROC Curve
Computed Tomography Angiography

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

@article{53da80afc6034e1aa452e392ac2a973f,
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 = "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.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.",
author = "{For the CONFIRM Investigators} and Reza Arsanjani and Berman, {Daniel S.} and Heidi Gransar and Cheng, {Victor Y.} and Allison Dunning and Lin, {Fay Y.} and Stephan Achenbach and Mouaz Al-Mallah and Budoff, {Matthew J.} and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Filippo Cademartiri and Chinnaiyan, {Kavitha M.} and Chow, {Benjamin J.W.} and Augustin DeLago and Martin Hadamitzky and Joerg Hausleiter and Philipp Kaufmann and LaBounty, {Troy M.} and Jonathon Leipsic and Gilbert Raff and Shaw, {Leslee J.} and Villines, {Todd C.} and Cury, {Ricardo C.} and Gudrun Feuchtner and Kim, {Yong Jin} and Min, {James K.}",
year = "2014",
month = "10",
day = "1",
doi = "10.1148/radiol.14122816",
language = "English",
volume = "273",
pages = "70--77",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "1",

}

TY - JOUR

T1 - Left ventricular function and volume with coronary CT angiography improves risk stratification and identification of patients at risk for incident mortality

T2 - Results from 7758 patients in the prospective multinational CONFIRM observational cohort study

AU - For the CONFIRM Investigators

AU - Arsanjani, Reza

AU - Berman, Daniel S.

AU - Gransar, Heidi

AU - Cheng, Victor Y.

AU - Dunning, Allison

AU - Lin, Fay Y.

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Budoff, Matthew J.

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Cademartiri, Filippo

AU - Chinnaiyan, Kavitha M.

AU - Chow, Benjamin J.W.

AU - DeLago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp

AU - LaBounty, Troy M.

AU - Leipsic, Jonathon

AU - Raff, Gilbert

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Cury, Ricardo C.

AU - Feuchtner, Gudrun

AU - Kim, Yong Jin

AU - Min, James K.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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.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.

AB - 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.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.

UR - http://www.scopus.com/inward/record.url?scp=84908676113&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908676113&partnerID=8YFLogxK

U2 - 10.1148/radiol.14122816

DO - 10.1148/radiol.14122816

M3 - Review article

C2 - 24991988

AN - SCOPUS:84908676113

VL - 273

SP - 70

EP - 77

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 1

ER -