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Increased Left Ventricular Myocardial Extracellular Volume Assessed by Cardiac Computed Tomography as a Consequence
Adrian Martuszewski1,2, Patrycja Paluszkiewicz2,3, Rafał Poręba4,5
1Department of Environmental Health, Occupational Medicine and Epidemiology, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-345 Wrocław, Poland.
Insights
Extracellular volume (ECV) expansion in patients undergoing transcatheter aortic valve implantation (TAVI) is linked to cardiovascular risk factors like hypertension and smoking, and more severe aortic stenosis (AS). This highlights ECV
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Extracellular volume (ECV) expansion may indicate myocardial fibrosis in severe aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVI).
- Assessing ECV can reveal subclinical myocardial remodeling before TAVI.
Purpose of the Study:
- To investigate the association between cardiovascular risk factors (CVRF), AS severity, and left ventricular myocardial ECV.
- To evaluate ECV measured by cardiac computed tomography (CCT) in TAVI candidates.
Main Methods:
- 61 TAVI candidates underwent pre-procedural CCT, recording CVRFs and performing non-contrast, angiographic, and delayed phase scans.
- ECV was calculated from interventricular septum and left ventricular cavity attenuation values.
- Patients were stratified by CVRFs, aortic valve calcium score (AVCS), and aortic valve area (AVA).
Main Results:
- Higher mean ECV was observed in patients with hypertension, smoking history, high AVCS (≥2975), and low AVA (<0.95 cm²).
- ECV positively correlated with the number of CVRFs, BMI, systolic blood pressure, and AVCS.
- AVA showed a negative correlation with ECV, and regression identified hypertension, smoking, and smaller AVA as independent predictors of higher ECV.
Conclusions:
- Hypertension, smoking, and advanced AS are independently associated with increased myocardial ECV in TAVI candidates.
- ECV measurement via CCT provides valuable insights into myocardial remodeling and may enhance pre-TAVI risk assessment.
Abstract:
Background/Objectives: Extracellular volume (ECV) expansion reflects myocardial fibrosis and may play a role in subjects with severe aortic stenosis (AS) receiving transcatheter aortic valve implantation (TAVI). This study aimed to assess the relationship between cardiovascular risk factors (CVRF), AS severity and left ventricular myocardial ECV measured by cardiac computed tomography (CCT). Methods: 61 patients qualified for TAVI underwent pre-procedural CCT. CVRFs were recorded, including advanced age, male gender, obesity, hypertension, hypercholesterolemia, hypertriglyceridemia, type 2 diabetes, and smoking. The CCT protocol included non-contrast (for aortic valve calcium score, AVCS), angiographic (for vascular access planning), and delayed phases (for left atrial appendage thrombus assessment). ECV was calculated from attenuation values of the interventricular septum and left ventricular cavity assessed in native and delayed phases. Patients were stratified based on the presence/absence of individual CVRFs, median AVCS, and aortic valve area (AVA). Results: Mean ECV was higher in patients with hypertension (28.01% vs. 26.93%, p = 0.03), smokers (28.71% vs. 26.52%, p = 0.01), AVCS ≥ 2975 (28.08% vs. 26.95%, p = 0.02), and AVA < 0.95 cm2 (28.63% vs. 26.53%, p = 0.01). Positive correlations were found between ECV and the number of CVRFs (r = 0.49, p = 0.01), BMI (r = 0.30, p = 0.01), systolic BP (r = 0.31, p = 0.02), and AVCS (r = 0.36, p = 0.01); AVA correlated negatively (r = -0.59, p = 0.01). Regression showed that hypertension, smoking, and smaller AVA were independent predictors of higher ECV. Conclusions: Among TAVI candidates, hypertension, smoking, and more advanced AS are independently associated with increased myocardial ECV on CCT. These findings may reflect subclinical myocardial remodeling and support the added diagnostic value of ECV in pre-TAVI assessment.
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