{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:22Z","timestamp":1787028922489,"version":"build-2736575974"},"reference-count":85,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: The Ejection Fraction (EF) represents a fundamental pillar for the phenotypic classification and clinical management of cardiovascular diseases. Although trans-thoracic echocardiography (TTE) acts as the first-line examination and cardiac magnetic resonance (CMR) is the reference gold standard, cardiac computed tomography (CCT) has undergone a technological evolution. The advent of wide-detector scanners and artificial intelligence (AI) models has enabled CCT to transition from a purely morphological tool to a modality capable of comprehensive, three-dimensional morpho-functional assessments. Methods: This narrative review evaluates the literature across Scopus, MEDLINE, and Web of Science regarding the calculation of biventricular function and EF using CCT. It provides an updated summary of current clinical applications, technological advancements, and comparative diagnostic reliability against TTE and CMR. Results: The CCT \u201cone-stop-shop\u201d concept allows for the simultaneous acquisition of anatomical data and systolic function metrics (EDV, ESV, SV, EF), optimizing clinical workflows at no additional cost. Being intrinsically three-dimensional, CCT bypasses the geometric assumptions and apical foreshortening artifacts typical of 2D-TTE, demonstrating high volumetric concordance with CMR. Nevertheless, structural limitations persist, primarily regarding ionizing radiation exposure, contrast media toxicity, dependence on heart rhythm stability, and lower temporal resolution compared to CMR. Conclusions: EF determination via CCT has achieved technical maturity and clinical validation. While it does not intend to replace TTE or CMR, it offers synergistic data when integrated with primary anatomical indications. Furthermore, AI integration has been shown to potentially automate this workflow, transforming CCT into an opportunistic screening tool for subclinical cardiac dysfunction.<\/jats:p>","DOI":"10.3390\/medicina62061084","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:45:08Z","timestamp":1780404308000},"page":"1084","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Calculation of Ejection Fraction Using Cardiac Computed Tomography: Clinical Evolution, Reliability, and Technological Challenges\u2014A Narrative Review"],"prefix":"10.3390","volume":"62","author":[{"given":"Simone","family":"Steffani","sequence":"first","affiliation":[{"name":"Diagnostic Imaging Department, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2935-2023","authenticated-orcid":false,"given":"Mariagrazia","family":"Piscione","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santissima Annunziata Hospital, ASL2, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Gaudio","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Campus Bio-Medico, University of Rome,  Alvaro del Portillo 200, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Meghnagi","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging Department, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca Guelfand","family":"Crignola","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital F. Spaziani, Via Armando Fabi, 03100 Frosinone, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1410-341X","authenticated-orcid":false,"given":"Luigi","family":"Asmundo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ospedale  Ca\u2019 Granda, Piazza Ospedale Maggiore, 20162 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4630-1090","authenticated-orcid":false,"given":"Corrado","family":"Tagliati","sequence":"additional","affiliation":[{"name":"AST Ancona, Ospedale di Comunit\u00e0 Maria Montessori di Chiaravalle, Via Fratelli Rosselli 176, 60033 Chiaravalle, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6094-6330","authenticated-orcid":false,"given":"Mario","family":"Laudazi","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging Department, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-4166","authenticated-orcid":false,"given":"Marcello","family":"Chiocchi","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging Department, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s10396-021-01116-z","article-title":"How to standardize the measurement of left ventricular ejection fraction","volume":"49","author":"Kusunose","year":"2022","journal-title":"J. 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