Abstract 19498: Abnormal Left ventricular Volumes Identified by Computed Tomography Improves Risk Stratification and Discrimination of Patients At Risk of Increased Mortality: Results from 3706 Patients in the Prospective Multicenter International CONFIRM Study
Background: Prior studies have evaluated the prognostic value of abnormal left ventricular end-systolic (LVESV) and end-diastolic (LVEDV) volumes by cardiac CT angiography. These studies were limited to smaller studies and single centers. We evaluated whether left ventricular volumes improves risk stratification and discrimination for mortality prediction in a large prospective study.
Methods: From 27125 subjects in the CONFIRM registry, we identified subjects without prior known coronary artery disease (CAD) who underwent CCTA with quantitative LVESV and LVEDV assessment. LVESV and LVEDV were categorized as normal (< 90ml and 90ml and > 200ml, respectively). CAD extent and severity was categorized as none (0%), non-obstructive ( 50%) 1-, 2- and 3-vessel disease. LVESV, LVEDV, and CAD were examined in relation to risk prediction and discrimination for future mortality employing Cox proportional hazards models and area under the receiver operating characteristics curve (AUC), respectively.
Results: In a follow-up of 2.2+0.9 years, 3706 patients (59.1 + 12.6 years, 54.2% male) were studied with 207 (5.6%) with abnormal LVESV and 190 (5.1%) with abnormal LVEDV. Abnormal volumes were associated with male gender, hypertension, smoking and younger age (p<0.05 for all). In multivariable analyses, increased volumes was independently associated with mortality for abnormal LVESV (hazards ratio (HR) 6.56, 95% confidence interval (CI) 3.75-11.46, p<0.001) and abnormal LVEDV (HR 4.00, 95% confidence interval 1.98-8.08, p<0.001). Abnormal LVEDV (AUC 0.8178) and LVESV (0.8335) improved discrimination for identification of individuals at risk of death, when compared to CAD risk factors alone (0.7745) or CAD extent and severity and risk factors (0.7819) [p<0.001].
Conclusions: Incremental to clinical variables and CAD extent and severity, abnormal left ventricular volumes by CCTA offers improved risk prediction and discrimination for future mortality.
- © 2012 by American Heart Association, Inc.