Clinical utility of systolic left ventricular ejection fraction in atrial fibrillation: Role of prospective ECG-triggered cardiac CT

Background The assessment of left ventricular (LV) systolic function and quantification of LV ejection fraction (LVEF) in patients with atrial fibrillation (AF) can be difficult. We previously demonstrated that LV volume changes over the 100 ms of systole (LVEF 100ms ) can be used as a measure of LV systolic function. Objective We sought to evaluate the applicability of LVEF 100ms in patients with AF. Methods We screened patients with AF who underwent prospective systolic electrocardiogram-triggered cardiac computed tomography from January 2015 to June 2023. The correlation between LVEF 100ms and echocardiography-derived LVEF was assessed. Patients were categorized into 3 groups on the basis of echocardiographic LVEF (≤40%, 40%–55%, and ≥55%), and LVEF 100ms was compared among these groups. Receiver operating characteristic curve analysis and Cox proportional hazards models were used to determine the optimal LVEF 100ms cutoff for predicting LVEF ≤ 40% and major adverse cardiovascular events ( MACE ), defined as a composite of cardiac death, myocardial infarction, heart failure hospitalization, and stroke. Results Of the total 123 patients, 62 (50.4%) had an LVEF of ≥55%, 40 (32.5%) had an LVEF of 40%–50%, and 21 (17.1%) had an LVEF of ≤40%. LVEF 100ms correlated with echocardiography-derived LVEF ( P < .001) and differed significantly among groups ( P < .001). LVEF 100ms ≤ 3.3% predicted LVEF ≤ 40% (area under the curve 0.809; sensitivity 87%; specificity 67%). Patients with an LVEF 100ms of ≤3.3% had a higher rate of MACE than did those without ( P = .030), and LVEF 100ms ≤ 3.3% was an independent predictor of MACE. Conclusion LVEF 100ms can provide a useful indicator of LV dysfunction in patients with AF undergoing prospective electrocardiogram-triggered cardiac computed tomography.