Calculation of Ejection Fraction Using Cardiac Computed Tomography: Clinical Evolution, Reliability, and Technological Challenges—A Narrative Review

Figures

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  Figure 3. Left Ventricular Segmentation on Cardiac Computed Tomography. Representative multiplanar reformations illustrating the volumetric segmentation of the left ventricle across (A) a short-axis view and (B) a two-chamber long-axis view. The endocardial border is delineated by the red contour, while the epicardial boundary is outlined in green. (C) A resulting table demonstrating how automated border detection allows for the precise quantification of LV dimensions and functional parameters, including EDV, ESV, and SV. These datasets enable the calculation of myocardial mass and the derivation of the EF. The cardiac output is also calculated and expressed in liters per minute (L/min), providing a comprehensive assessment of cardiac performance.

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  Figure 1. Evolution of the ejection fraction concept. Historical progression of TTE methods for calculating EF. The panel illustrates the transition from linear measurements relying on fixed geometric assumptions to the currently recommended biplane method of disk summation.

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  Figure 2. TTE Calculation of EF: Modified Simpson’s Measurement. Assessment of EDV and ESV using 2D-TTE according to the preferred biplane method of disks. The evaluation of these volumes is important, as LVEF represents a composite parameter that reflects both global ventricular structure and the overall haemodynamic state.

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  Figure 4. The “One-Stop-Shop” Concept in modern CCT.

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  Figure 5. Integrated Cardiac Computed Tomography Pathway for the Etiological Diagnosis and Management of New-Onset HFrEF.

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  Figure 6. Biventricular Segmentation on Cardiac Computed Tomography. (A) Representative multiplanar reformations illustrating the volumetric segmentation across short-axis and (B) four-chamber view. The LV endocardial border is delineated by the red contour, while the epicardial boundary is outlined in green. The RV endocardium is segmented with a yellow line. Automated border detection allows for the precise quantification of biventricular dimensions and functional parameters. (C) The accompanying table displays the EDV and ESV for both the left and right ventricles. These datasets enable the calculation of myocardial mass and the derivation of the EF and SV, providing a comprehensive assessment of cardiac performance.