Highlights
- •The low preoperative ECV by CT predicts better outcome in AS patients after TAVI.
- •The low preoperative ECV by CT predicts LVM regression in AS patients after TAVI.
- •Cardiac CT has been used to quantify myocardial ECV.
Abstract
Background
Transcatheter aortic valve implantation (TAVI) improved outcome of patients with severe
aortic valve stenosis (AS). Myocardial fibrosis is associated with AS-related pathological
left ventricular (LV) remodeling and predicts cardiovascular mortality after TAVI.
The present study aimed to investigate the impact of preoperative extracellular volume
(ECV) assessed by computed tomography (CT) on left ventricular mass (LVM) regression
and clinical outcomes in severe AS patients after TAVI.
Methods
We examined 71 consecutive severe AS patients who underwent CT with ECV determination
before TAVI. ECV was calculated as the ratio of the change in Hounsfield units in
the myocardium and LV blood before and after contrast administration, multiplied by
(1-hematocrit). Delayed scan was performed at 5 min after contrast injection. Echocardiography
was performed before and 6 months after TAVI. The primary endpoint was heart failure
(HF) hospitalization after TAVI. Patients were divided into two subgroups according
to the median value of global ECV with 32 % (Low-ECV group: n = 35, and High-ECV group:
n = 36).
Results
No significant differences were observed in background characteristics between the
2 groups. However, the preoperative LV ejection fraction and LVM index were similar
between the 2 groups, the Low-ECV group had greater LVM index reduction than the High-CV
group after 6 months (p < 0.001). Kaplan-Meier curves demonstrated that the High-ECV group had significantly
higher rate of HF hospitalization than the Low-ECV group (p = 0.016). In addition, multivariate analyses identified high global ECV as an independent
predictor of HF hospitalization (HR 10.8, 95 % confidence interval 1.36 to 84.8, p = 0.024).
Conclusion
The low preoperative ECV assessed by CT is associated with the greater LVM regression,
and predict better outcome in AS patients after TAVI.
Graphical abstract
Graphical Abstract
Abbreviations:
ECV (extracellular volume), CT (computed tomography), AS (aortic valve stenosis), TAVI (transcatheter aortic valve replacement), LVM (left ventricular mass)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.N Engl J Med. 2019; 380: 1695-1705
- Myocardial fibrosis and cardiac decompensation in aortic stenosis.JACC Cardiovasc Imaging. 2017; 10: 1320-1333
- Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease.J Am Coll Cardiol. 2010; 56: 278-287
- Midwall fibrosis is an independent predictor of mortality in patients with aortic stenosis.J Am Coll Cardiol. 2011; 58: 1271-1279
- Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis.Circulation. 2009; 120: 577-584
- Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery.J Thorac Cardiovasc Surg. 2001; 122: 919-928
- Timing of intervention in aortic stenosis: a review of current and future strategies.Heart. 2018; 104: 2067-2076
- Calcific aortic stenosis.J Am Coll Cardiol. 2018; 60: 1854-1863
- Progression from compensated hypertrophy to failure in the pressure-overloaded human heart.Circulation. 2003; 107: 984-991
- Early regression of severe left ventricular hypertrophy after transcatheter aortic valve replacement is associated with decreased hospitalizations.JACC Cardiovasc Interv. 2014; 7: 662-673
- Prognostic impact of left ventricular mass regression after transcatheter aortic valve replacement in patients with left ventricular hypertrophy.Int J Cardiol. 2021; 332: 60-66
- Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the Society for Cardiovascular Magnetic Resonance(SCMR) endorsed by the european Association for Cardiovascular Imaging.J Cardiovasc Magn Reson. 2017; 19: 75
- Prognostic value of T1-mapping in TAVR patients: extra-cellular volume as a possible predictor for peri- and post-TAVR adverse events.Int J Cardiovasc Imaging. 2016; 32: 1625-1633
- Computed tomography for planning transcatheter aortic valve replacement.J Thorac Imaging. 2013; 28: 231-239
- Data on correlation between CT-derived and MRI-derived myocardial extracellular volume.Data Br. 2016; 7: 1045-1047
- Myocardial extracellular volume quantification by cardiovascular magnetic resonance and computed tomography.Curr Cardiol Rep. 2018; 20: 3
- Estimation of myocardial extracellular volume fraction with cardiac CT in subjects without clinical coronary artery disease: a feasibility study.J Cardiovasc Comput Tomogr. 2016; 10: 237-241
- Feasibility of extracellular volume fraction calculation using myocardial CT delayed enhancement with low contrast media administration.J Cardiovasc Comput Tomogr. 2020; 14: 524-528
- Prognostic value of cardiac CT delayed enhancement imaging in patients with suspected coronary artery disease.JACC Cardiovasc Imaging. 2021; 8: 1674
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22: 1-23
- Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.Am J Cardiol. 1986; 7: 450-458
- Effect of sex and sporting discipline on LV adaptation to exercise.JACC Cardiovasc Imaging. 2017; 10: 965-972
- Predictors and changes in cardiac hemodynamics and geometry with transcatheter aortic valve implantation.Am J Cardiol. 2019; 123: 813-819
- Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the valve academic research consortium.J Am Coll Cardiol. 2011; 57: 253-269
- Valve academic research consortium (VARC)-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation.Eur J Cardiothorac Surg. 2012; 42: S45-S60
- Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research.J Am Coll Cardiol. 2021; 77: 2717
- Prognostic value of computed tomography–derived extracellular volume in TAVR patients with low-flow low-gradient aortic stenosis.JACC Cardiovasc Imaging. 2020; 13: 2591-2601
- Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis.PLOS One. 2021; 16e0248306
- Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: a cardiovascular magnetic resonance study.Am Heart J. 2016; 175: 101-111
- Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis.J Thorac Cardiovasc Surg. 2014; 147: 362-369
- Regression of left ventricular mass after transcatheter aortic valve replacement.J Am Coll Cardiol. 2020; 75: 2446-2458
- Transcatheter aortic valve replacement and left ventricular geometry: survival and gender differences.J Am Soc Echocardiogr. 2020; 33: 1357-1362
- Calcific aortic stenosis: a disease of the valve and the myocardium.J Am Coll Cardiol. 2012; 60: 1854-1863
- Is cardiac hypertrophy good or bad? The answer, of course, is yes.JACC Cardiovasc Imaging. 2014; 7: 1081-1083
- Cardiac plasticity.N Engl J Med. 2008; 358: 1370-1380
- Prognostic impact of myocardial extracellular volume fraction assessment using dual-energy computed tomography in patients treated with aortic valve replacement for severe aortic stenosis.J Am Heart Assoc. 2021; 10e020655
- Computed tomography angiography-derived extracellular volume fraction predicts early recovery of left ventricular systolic function after transcatheter aortic valve replacement.Eur Heart J Cardiovasc Imaging. 2021; 22: 179-185
- Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis.J Am Coll Cardiol. 2020; 54: 1003-1011
- Impact of valvulo-arterial impedance on long-term quality of life and exercise performance after transcatheter aortic valve replacement.Circ Cardiovasc Interv. 2020; 13e008372
- Preprocedural valvuloarterial impedance as a predictor of left ventricular ejection fraction improvement after transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction.Heart Vessels. 2020; 35: 1209-1217
- Identifying cardiac amyloid in aortic stenosis: ECV quantification by CT in TAVR patients.JACC Cardiovasc Imaging. 2020; 13: 2177-2189
Article info
Publication history
Published online: December 20, 2022
Accepted:
November 25,
2022
Received in revised form:
November 23,
2022
Received:
July 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
