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CT-derived extracellular volume fraction in aortic stenosis, cardiac amyloidosis, and dual pathology
Masafumi Kidoh1, Seitaro Oda1, Noriaki Tabata2
1Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Insights
This study found that computed tomography-derived extracellular volume fraction (CT-ECV) can help differentiate cardiac conditions. CT-ECV values were lower in patients with dual aortic stenosis and transthyretin amyloidosis compared to those with lone aortic stenosis.
Area of Science:
- Cardiovascular Imaging
- Cardiac Amyloidosis
- Aortic Stenosis
Background:
- Distinguishing between lone aortic stenosis (AS) and dual pathology of AS with transthyretin cardiac amyloidosis (AS-ATTR) is clinically important.
- Transthyretin amyloidosis (ATTR) can coexist with AS, affecting patient management and prognosis.
- Computed tomography-derived extracellular volume fraction (CT-ECV) is a promising imaging biomarker for diffuse myocardial diseases.
Purpose of the Study:
- To evaluate CT-ECV in patients with lone AS, AS-ATTR, and lone ATTR.
- To assess the diagnostic performance of CT-ECV in differentiating these conditions.
- To determine optimal CT-ECV cut-off values for distinguishing lone AS from AS-ATTR and lone AS from lone ATTR.
Main Methods:
- Retrospective analysis of 138 patients with severe AS or lone ATTR who underwent CT-ECV and technetium 99m pyrophosphate (99mTc-PYP) scintigraphy.
- Patients were categorized into lone AS (n=55), AS-ATTR (n=19), and lone ATTR (n=64).
- Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance and determine optimal cut-off values.
Main Results:
- CT-ECV was significantly lower in AS-ATTR patients compared to lone ATTR patients (45 ± 12% vs. 53 ± 13%, P = 0.04).
- The area under the ROC curve (AUC) for differentiating AS-ATTR from lone AS was 0.90, while for lone ATTR from lone AS it was 0.95.
- Optimal CT-ECV cut-off values for differentiating lone AS from AS-ATTR (36.6%) were lower than for differentiating lone AS from lone ATTR (38.5%).
Conclusions:
- CT-ECV effectively differentiates lone AS from AS-ATTR and lone ATTR.
- Despite similar 99mTc-PYP scintigraphy findings between AS-ATTR and lone ATTR, CT-ECV shows significant differences.
- CT-ECV offers valuable diagnostic information for complex cardiovascular conditions involving AS and ATTR.
Aims:
To investigate CT-derived extracellular volume fraction (CT-ECV) in patients with lone aortic stenosis (AS), dual pathology of AS and transthyretin cardiac amyloidosis (AS-ATTR), and lone ATTR, and to examine the diagnostic performance and optimal cut-off values of CT-ECV for differentiating between patients with lone AS and AS-ATTR and between patients with lone AS and lone ATTR.
Methods And Results:
This retrospective study included consecutive patients with severe AS (including lone AS and AS-ATTR) and lone ATTR who underwent CT-ECV analysis and technetium 99 m pyrophosphate (99mTc-PYP) scintigraphy. The diagnostic performance of CT-ECV for detecting cardiac amyloidosis was evaluated using the area under the receiver operating characteristic curve (AUC). Of 138 patients (mean age, 80 ± 8; 96 men), 55 had lone AS, 19 had AS-ATTR, and 64 had lone ATTR. CT-derived extracellular volume fraction of patients with lone AS was 31 ± 5%. CT-derived extracellular volume fraction was significantly lower in patients with AS-ATTR than lone ATTR (45 ± 12% vs. 53 ± 13%, P = 0.04). The AUC for differentiating patients with AS-ATTR from lone AS was lower than for lone ATTR from lone AS [0.90 (95% CI: 0.81, 0.96) vs. 0.95 (95% CI: 0.90, 0.98)]. The cut-off values of CT-ECV for differentiation between patients with lone AS and AS-ATTR were lower than those between patients with lone AS and lone ATTR [36.6% vs. 38.5% (Youden index)]. There was no significant difference in the proportion of 99mTc-PYP scintigraphy grade between patients with AS-ATTR and lone ATTR (P = 0.20).
Conclusion:
Despite no significant difference in degree of ATTR between patients with AS-ATTR and lone ATTR, CT-ECV of patients with dual AS-ATTR pathology was significantly lower than that of patients with lone ATTR. The diagnostic performance and optimal cut-off values of CT-ECV for differentiating between patients with lone AS and AS-ATTR were lower than those between patients with lone AS and lone ATTR.
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