Computed Tomography-Derived Left Ventricular Extracellular Volume Predicts Reverse Remodeling After Catheter Ablation...

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Left ventricular (LV) extracellular volume fraction (ECV) via cardiac CT assesses diffuse myocardial fibrosis.
• Differentiating tachycardia-induced cardiomyopathy from underlying myocardial disease in atrial fibrillation (AF) patients with reduced LV ejection fraction (LVEF) is difficult.
• The prognostic role of ECV in predicting reverse remodeling (RR) post-AF catheter ablation is unclear.

Purpose of the Study:

• To evaluate the prognostic value of cardiac CT-derived ECV for predicting RR after AF catheter ablation in patients with reduced LVEF.
• To determine if ECV can help distinguish between different causes of cardiomyopathy in AF patients.
• To assess the association between pre-ablation ECV and post-ablation cardiac remodeling.

Main Methods:

• Retrospective analysis of 102 patients with LVEF ≤ 50% undergoing cardiac CT before AF ablation.
• Definition of RR: ≥15% reduction in LV end-systolic volume with LVEF > 50%, or an absolute LVEF increase of ≥15%.
• Statistical analysis including receiver operating characteristic (ROC) and multivariable logistic regression.

Main Results:

• RR occurred in 48% of patients.
• Patients with RR had significantly lower pre-ablation ECV compared to those without (31.2% vs. 37.6%, p < 0.001).
• An ECV cutoff of 34.8% predicted RR with 88% sensitivity and 62% specificity (AUC 0.77, p < 0.001). Lower ECV was independently associated with RR (OR 0.84, p = 0.006).

Conclusions:

• Cardiac CT-derived ECV is associated with RR after AF ablation in patients with reduced LVEF.
• Lower pre-ablation ECV predicts successful reverse remodeling post-ablation.
• ECV may offer valuable prognostic information for clinical decision-making in AF patients undergoing ablation.