Regional Distribution of Extracellular Volume Quantified by Cardiac CT in Aortic Stenosis: Insights Into Disease Mechanisms and Impact on Outcomes.
Volume
17
Pagination
e015996 - ?
Publisher
DOI
10.1161/CIRCIMAGING.123.015996
Journal
Circ Cardiovasc Imaging
Issue
Metadata
Show full item recordAbstract
BACKGROUND: Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECVCT), and has prognostic utility in several diseases. This study aims to map out regional differences in ECVCT to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications. METHODS: Three prospective cohorts were included: patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts. Controls had CT angiography and cardiac magnetic resonance demonstrating no significant coronary artery disease or infarction. Global and regional ECVCT was analyzed, and its association with mortality was assessed for patients with AS. RESULTS: In 199 patients, controls (n=65; 66% male), AS (n=115), and coexisting AS and transthyretin cardiac amyloidosis (n=19) had a global ECVCT of 26.1 (25.0-27.8%) versus 29.1 (27.5-31.1%) versus 37.4 (32.5-46.6%), respectively; P<0.001. Across cohorts, ECVCT was higher at the base (versus apex), the inferoseptum (versus anterolateral wall), and the subendocardium (versus subepicardium); P<0.05 for all. Among patients with AS, epicardial ECVCT, rather than any other regional value or global ECVCT, was the strongest predictor of mortality at a median of 3.9 (max 6.3) years (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.36]; P=0.002). CONCLUSIONS: Regional differences in ECVCT suggest a predilection for fibrosis and amyloid infiltration at the base, subendocardium, inferior wall, and septum more than the anterior and lateral myocardium. ECVCT can predict long-term mortality with the subepicardium demonstrating the strongest discriminatory power. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03029026 and NCT03094143.
Authors
Patel, KP; Scully, PR; Saberwal, B; Sinha, A; Yap-Sanderson, JJL; Cheasty, E; Mullen, M; Menezes, LJ; Moon, JC; Pugliese, FCollections
- NIHR Advanced Imaging [382]
Language
Related items
Showing items related by title, author, creator and subject.
-
Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation
Hansson, NC; Leipsic, J; Pughese, F; Andersen, HR; Rossi, A; Simonato, M; Jensen, KT; Christiansen, EH; Terkelsen, CJ; Blanke, P (2018) -
Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.
Saito, Y; Nazif, T; Baumbach, A; Tchétché, D; Latib, A; Kaple, R; Forrest, J; Prendergast, B; Lansky, A (American Medical Association, 2019-11-13)Importance: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks ... -
Transcatheter aortic valve implantation in acute decompensated aortic stenosis
Patel, K; Broyd, C; Chehab, O; Jerrum, M; Queenan, H; Bedford, K; Barakat, F; Kennon, S; Ozkor, M; Mathur, A (2020-09-01)