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Regional Distribution of Extracellular Volume Quantified by Cardiac CT in Aortic Stenosis: Insights Into Disease Mechanisms and Impact on Outcomes.
Patel, Kush P; Scully, Paul R; Saberwal, Bunny; Sinha, Apurva; Yap-Sanderson, Joanna J L; Cheasty, Emma; Mullen, Michael; Menezes, Leon J; Moon, James C; Pugliese, Francesca; Klotz, Ernst; Treibel, Thomas A.
Afiliación
  • Patel KP; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Scully PR; Institute of Cardiovascular Sciences, University College London, United Kingdom (K.P.P., P.R.S., J.C.M., T.A.T.).
  • Saberwal B; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Sinha A; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Yap-Sanderson JJL; William Harvey Research Institute, Queen Mary University of London, United Kingdom (B.S., F.P., T.A.T.).
  • Cheasty E; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Mullen M; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Menezes LJ; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Moon JC; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Pugliese F; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).
  • Klotz E; Institute of Nuclear Medicine, University College London, United Kingdom (L.J.M.).
  • Treibel TA; NIHR University College London Hospitals Biomedical Research Centre, United Kingdom (L.J.M.).
Circ Cardiovasc Imaging ; 17(5): e015996, 2024 May.
Article en En | MEDLINE | ID: mdl-38771906
ABSTRACT

BACKGROUND:

Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECVCT), and has prognostic utility in several diseases. This study aims to map out regional differences in ECVCT to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications.

METHODS:

Three prospective cohorts were included patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts. Controls had CT angiography and cardiac magnetic resonance demonstrating no significant coronary artery disease or infarction. Global and regional ECVCT was analyzed, and its association with mortality was assessed for patients with AS.

RESULTS:

In 199 patients, controls (n=65; 66% male), AS (n=115), and coexisting AS and transthyretin cardiac amyloidosis (n=19) had a global ECVCT of 26.1 (25.0-27.8%) versus 29.1 (27.5-31.1%) versus 37.4 (32.5-46.6%), respectively; P<0.001. Across cohorts, ECVCT was higher at the base (versus apex), the inferoseptum (versus anterolateral wall), and the subendocardium (versus subepicardium); P<0.05 for all. Among patients with AS, epicardial ECVCT, rather than any other regional value or global ECVCT, was the strongest predictor of mortality at a median of 3.9 (max 6.3) years (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.36]; P=0.002).

CONCLUSIONS:

Regional differences in ECVCT suggest a predilection for fibrosis and amyloid infiltration at the base, subendocardium, inferior wall, and septum more than the anterior and lateral myocardium. ECVCT can predict long-term mortality with the subepicardium demonstrating the strongest discriminatory power. REGISTRATION URL https//www.clinicaltrials.gov; Unique identifiers NCT03029026 and NCT03094143.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Fibrosis / Neuropatías Amiloides Familiares / Angiografía por Tomografía Computarizada / Miocardio Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Cardiovasc Imaging Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Fibrosis / Neuropatías Amiloides Familiares / Angiografía por Tomografía Computarizada / Miocardio Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Cardiovasc Imaging Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos