Abstract
Background
Computed tomography angiography (CTA) assessment of myocardial extracellular volume
fraction (CT-ECV) is feasible, although the protocols for imaging acquisition and
post-processing methodology have varied. We aimed to identify a pragmatic protocol
for CT-ECV assessment encompassing both imaging acquisition and post-processing methodologies
to facilitate its clinical implementation.
Methods
We evaluated consecutive patients with severe aortic stenosis undergoing evaluation
for transcatheter aortic valve replacement (TAVR). Pre-contrast and 3-min-delayed
CTA were obtained in systole using either helical prospective-ECG-triggered (high-pitch)
or axial sequential-ECG-gated acquisition, adding to standard TAVR CTA protocol. Using
a dedicated software for co-registration of CTA datasets, three methodologies for
ECV measurement were evaluated: (1) mid-septum region of interest (Septal ECV), (2)
averaged-global ECV (Global ECV) encompassing 16-AHA segments, and (3) average of
septal and lateral segments (Averaged ECVsep and Averaged ECVlat).
Results
Among the 142 patients enrolled (median = 81 years, 44% females), 8 were excluded
due to significant imaging artifacts precluding Global ECV assessment. High-pitch
scan mode was performed in 68 patients (48%). Suboptimal image quality for Global
ECV assessment was associated with high-pitch scan mode (odds ratio: OR = 2.26,
p = 0.036), along with the presence of intracardiac leads (OR = 4.91, p = 0.002),
and BMI≥35 kg/m2 (OR = 2.80, p = 0.026). Septal ECV [median = 29.4%] and Averaged ECVsep [29.0%]
were similar (p = 0.108), while Averaged ECVlat [27.5%] was lower than Averaged
ECVsep (p < 0.001), resulting in lower Global ECV [28.6%].
Conclusions
Myocardial CT-ECV assessment is feasible using a systolic sequential acquisition pre-contrast,
and similar additional 3-min delayed scan. Septal ECV measurement provides similar
values to Global ECV and is equally reproducible.
Keywords
Abbreviations:
AF (atrial fibrillation), AS (aortic stenosis), BMI (body mass index), CTA (computed tomography angiography), ECV (extracellular volume fraction), ECG (electrocardiography), MRI (magnetic resonance imaging)To read this article in full you will need to make a payment
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References
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Article info
Publication history
Published online: March 13, 2023
Accepted:
February 24,
2023
Received in revised form:
February 12,
2023
Received:
December 29,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
