Comparative Assessment of CMR-Determined Extracellular Volume Metrics in Predicting Adverse Outcomes

Area of Science:

• Cardiology
• Medical Imaging
• Biomarkers

Background:

• Extracellular volume (ECV) assessed by cardiovascular magnetic resonance (CMR) imaging correlates with disease severity and patient outcomes.
• Indexed total ECV (iECV) has been proposed as a superior prognostic marker in valvular heart disease (VHD).

Purpose of the Study:

• To compare the prognostic capabilities of conventional ECV and iECV in a broad cohort of patients undergoing CMR.
• To determine if iECV offers additional prognostic value over standard ECV.

Main Methods:

• A consecutive cohort of 1525 patients underwent ECV and iECV measurements via CMR between January 2012 and 2023.
• Adverse outcomes were defined as a composite of heart failure hospitalization and/or all-cause mortality.
• Multivariate analysis adjusted for clinical factors and echocardiographic data was performed.

Main Results:

• Both ECV and iECV were significantly associated with adverse outcomes in univariate and multivariate analyses.
• Kaplan-Meier analyses demonstrated a significant association between ECV/iECV tertiles and event-free survival.
• While ECV correlated with aortic valve velocity, iECV did not show a significant association.

Conclusions:

• Both conventional ECV and iECV are valuable prognostic markers for predicting heart failure hospitalizations and death in an all-comer CMR cohort.
• Despite its complexity, iECV did not demonstrate added prognostic value compared to standard ECV measurements.