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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
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Association of Cardiac Damage and Computed Tomography-Derived Extracellular Volume in Patients Undergoing

Marta Belmonte1, Pasquale Paolisso2, Elayne Kelen de Oliveira3

  • 1Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy; Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy.

The Canadian Journal of Cardiology
|March 1, 2025
PubMed

Insights

Elevated extracellular volume (ECV) measured by cardiac CT predicts cardiac damage progression and limits functional recovery after transcatheter aortic valve implantation (TAVI) in severe aortic stenosis patients.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Severe aortic stenosis (AS) poses risks, with extravalvular cardiac damage (EVCD) and extracellular volume (ECV) impacting outcomes after transcatheter aortic valve implantation (TAVI).
  • Assessing ECV via cardiac computed tomography (CT) is crucial for understanding EVCD dynamics.
  • This study investigates the link between CT-derived ECV and EVCD before and after TAVI.

Purpose of the Study:

  • To evaluate the association of CT-derived ECV with EVCD progression and severity post-TAVI.
  • To determine ECV's impact on left ventricular reverse remodeling and functional status at 3-month follow-up.
  • To identify predictors of EVCD progression and functional improvement after TAVI.

Main Methods:

  • A prospective study involving 73 patients undergoing TAVI, with baseline and follow-up CT and echocardiography.
  • ECV cutoff values were determined to predict EVCD progression and advanced stages.
  • Logistic regression analysis identified predictors of EVCD progression and functional outcomes.

Main Results:

  • A significant portion (34.2%) of patients experienced EVCD progression at 3 months.
  • ECV ≥ 32% effectively predicted EVCD progression and advanced stages (ROC AUC 0.66, P < 0.001).
  • High ECV patients showed more advanced EVCD (P=0.011) and greater progression (P=0.012). Low ECV patients had better LV reverse remodeling (P=0.004) and NYHA functional class improvement (P=0.020 at 3 months, P=0.001 at 6 months).

Conclusions:

  • Elevated CT-derived ECV is linked to increased EVCD progression after TAVI.
  • High ECV independently predicts EVCD progression, advanced stages, and lack of functional improvement post-TAVI.
  • ECV measurement offers valuable prognostic information for TAVI patients.
Abstract

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