CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis
Introduction: Prior to transcutaneous aortic valve replacement (TAVR), a CT is performed (TAVR-CT). With modification, the CT exam can measure myocardial extracellular volume (ECV). A small increase in ECV occurs in severe aortic stenosis. A large increase in ECV occurs when transthyretin cardiac am...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-08-01
|
| Series: | American Heart Journal Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000783 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction: Prior to transcutaneous aortic valve replacement (TAVR), a CT is performed (TAVR-CT). With modification, the CT exam can measure myocardial extracellular volume (ECV). A small increase in ECV occurs in severe aortic stenosis. A large increase in ECV occurs when transthyretin cardiac amyloidosis (ATTR-CA) co-exists. We sought to determine the prognostic potential of ECV in severe aortic stenosis and test the utility of threshold ECV to instigate screening for ATTR-CA. Methods: This was a prospective observation study of consecutive severe AS patients undergoing CT -TAVR. A delayed cardiac acquisition was acquired 5 min post TAVR-CT. Pre-contrast and delayed -images were used to determine ECV. When ECV ≥ 31 % 99mTc-pyrophosphate (PYP) imaging was performed. The primary end point was all cause mortality. Results: During the study, 161 patients underwent aortic valve replacement and were included in the analysis. Mean age was 81.6 (±6.2) years. During median follow up of 29 (21–36) months, 24 deaths occurred.In 30 patients ECV ≥ 31 %, 2 had positive 99mTc-PYP imaging for ATTR-CA. On Cox regression analysis increased ECV associated with increased risk of all cause mortality (HR 2.54 (95 % CI 1.09–5.93) and was incremental to age, LV function and renal impairment (p = 0.03). Conclusion: In severe AS, elevated ECV was a risk for all cause mortality, but this was not related to co-existent ATTR-CA. Threshold-ECV testing for ATTR-CA demonstrated a low yield. Threshold testing may therefore not be warranted in all severe AS patients with an ECV ≥ 31 %. |
|---|---|
| ISSN: | 2666-6022 |