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Combining late iodine enhancement (LIE) and extracellular volume fraction (ECV) detected via cardiac computed tomography (CCT) improves cardiovascular risk prediction. Patients with both LIE and elevated ECV face significantly higher risks of adverse outcomes.

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Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Cardiac Computed Tomography

Background:

  • Cardiac computed tomography (CCT) offers insights into coronary anatomy and myocardial tissue characteristics.
  • Delayed phase imaging, including extracellular volume fraction (ECV) for diffuse fibrosis and late iodine enhancement (LIE) for focal fibrosis, provides complementary information.
  • Distinct pathological processes underlie ECV and LIE, suggesting combined assessment could enhance detection of subclinical myocardial injury.

Purpose of the Study:

  • To evaluate the prognostic value of LIE and ECV in patients undergoing CCT for coronary artery assessment.
  • To determine the association of combined LIE and ECV with clinical outcomes, including all-cause death and cardiovascular hospitalizations.

Main Methods:

  • Analysis of 1,207 consecutive patients undergoing CCT.
  • Categorization into four groups based on the presence of LIE and elevated ECV.
  • Assessment of associations using Cox proportional hazards models and Kaplan-Meier analysis over a mean follow-up of 26.0 months.

Main Results:

  • A stepwise increase in risk was observed across the four groups.
  • Patients with both LIE and elevated ECV exhibited the highest cumulative incidence of composite events (log-rank p = 0.027).
  • This group demonstrated a significantly increased risk for the composite outcome (HR 1.84) and cardiovascular events (HR 2.67).

Conclusions:

  • The coexistence of LIE and elevated ECV in patients undergoing CCT is linked to a heightened risk of cardiovascular events.
  • Combined assessment of LIE and ECV offers synergistic prognostic value in coronary artery evaluation.
  • This dual-marker approach may improve risk stratification in patients evaluated with CCT.