Extracellular Volume Fraction by Computed Tomography Predicts Long-Term Prognosis Among Patients With Cardiac Amyloidosis

Gama, F; Rosmini, Stefania; Bandula, Steve; Patel, Kush; Massa, Paolo; Tobon-Gómez, Catalina; Ecke, Karolin; Stroud, Tyler; Condron, Mark; Thornton, George; Bennett, Jonathan; Wechelakar, Ashutosh; Gillmore, Julian D.; Whelan, Carol; Lachmann, Helen; taylor, stuart; Pugliese, Francesca; Torto, Alberico Del; Moon, James; Hawkins, Philip N.; Treibel, Thomas A.

doi:10.1016/j.jcmg.2022.08.006

Cited by 22 publications

(15 citation statements)

References 40 publications

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“…Extra-cellular volume can be quantified by CT, demonstrating high reproducibility and an age-related increase, which suggest the marker to be consistent with the actual pathologic changes in the myocardium [90]. In patients with amyloidosis, ECV by CT is associated with markers of more advanced disease and higher mortality at follow-up [91]. However, the need for iodinate contrast media administration, which has well-known nephrotoxic effects, especially in patients with underlying pre-existent renal disease [92], limits this application in patients with CKD.…”

Section: Computed Tomographymentioning

confidence: 83%

Cardiac Imaging Biomarkers in Chronic Kidney Disease

Valbuena-López

Camastra²,

Cacciotti³

et al. 2023

Biomolecules

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Uremic cardiomyopathy (UC), the peculiar cardiac remodeling secondary to the systemic effects of renal dysfunction, is characterized by left ventricular (LV) diffuse fibrosis with hypertrophy (LVH) and stiffness and the development of heart failure and increased rates of cardiovascular mortality. Several imaging modalities can be used to obtain a non-invasive assessment of UC by different imaging biomarkers, which is the focus of the present review. Echocardiography has been largely employed in recent decades, especially for the determination of LVH by 2-dimensional imaging and diastolic dysfunction by pulsed-wave and tissue Doppler, where it retains a robust prognostic value; more recent techniques include parametric assessment of cardiac deformation by speckle tracking echocardiography and the use of 3D-imaging. Cardiac magnetic resonance (CMR) imaging allows a more accurate assessment of cardiac dimensions, including the right heart, and deformation by feature-tracking imaging; however, the most evident added value of CMR remains tissue characterization. T1 mapping demonstrated diffuse fibrosis in CKD patients, increasing with the worsening of renal disease and evident even in early stages of the disease, with few, but emerging, prognostic data. Some studies using T2 mapping highlighted the presence of subtle, diffuse myocardial edema. Finally, computed tomography, though rarely used to specifically assess UC, might provide incidental findings carrying prognostic relevance, including information on cardiac and vascular calcification. In summary, non-invasive cardiovascular imaging provides a wealth of imaging biomarkers for the characterization and risk-stratification of UC; integrating results from different imaging techniques can aid a better understanding of the physiopathology of UC and improve the clinical management of patients with CKD.

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Section: Computed Tomographymentioning

confidence: 83%

Cardiac Imaging Biomarkers in Chronic Kidney Disease

Valbuena-López

Camastra²,

Cacciotti³

et al. 2023

Biomolecules

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“… 19 Myocardial infiltration by amyloid fibrils causes extracellular expansion, and cardiac amyloidosis contributes to the diagnosis and prognosis by evaluating ECV. 20 Transthyretin cardiac amyloidosis is observed in 13% of elderly patients with heart failure with preserved ejection fraction 21 and in one in seven elderly patients aged ≥75 years with severe aortic stenosis undergoing TAVI. 22 Recent investigations of the clinical characteristics of wild-type ATTR-CA revealed that the median age at diagnosis was ≥70 years.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of patients with high extracellular volume fraction evaluated by cardiac computed tomography for coronary artery evaluation

Oguni,

Takashio,

Kuyama

et al. 2024

European Heart Journal Open

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Aim To evaluate the distribution of extracellular volume fraction detected via computed tomography, clinical characteristics of high extracellular volume fraction detected via computed tomography, and the rate of incidental detection of cardiac amyloidosis in patients undergoing cardiac computed tomography for coronary artery evaluation. Methods and Results This study included 874 consecutive patients (mean age, 74.4 ± 7.1 years; men, 65%), comprising men aged ≥60 years and women aged ≥70 years, who had undergone cardiac computed tomography between January 2020 and September 2022. The mean extracellular volume fraction detected via computed tomography was 29.7 ± 5.2%, and 108 patients (12.4%) had an extracellular volume fraction detected via computed tomography of ≥35%. Older age (75.9 ± 8.2 years vs. 74.2 ± 6.9 years; P = 0.042), male sex (75.9% vs. 63.0%; P = 0.007), impaired left ventricular ejection fraction, increased high-sensitivity cardiac troponin T and B-type natriuretic peptide levels, and increased left ventricular thickness showed significant associations with an extracellular volume fraction detected via computed tomography of ≥35%. Cardiac amyloidosis was diagnosed incidentally in 15 patients based on an increase in extracellular volume fraction detected via computed tomography. The prevalence of cardiac amyloidosis was 1.7% (15/874) and 14.3% (15/105) in the entire study population and in patients with an extracellular volume fraction detected via computed tomography of ≥35%, respectively. An increase in the extracellular volume fraction detected via computed tomography was suggestive of cardiac amyloidosis. Conclusion Elevated extracellular volume fraction detected via computed tomography, associated with elevated cardiac biomarker levels and myocardial structural changes, may lead to the incidental diagnosis of cardiac amyloidosis.

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“…10 Second, beyond the potential to risk stratify patients with AS using ECV CT in terms of function and recovery after treatment, ECV CT could be particularly relevant in AS due to the presence of concomitant transthyretin amyloidosis cardiomyopathy (ATTR-CM) in ≈10% of cases, 11 characterized by significant ECV elevations. 12,13 Initially, concerns about ECV CT centered on additional radiation exposure; however, technical advancements have significantly mitigated this risk. Furthermore, procedural complexity has been simplified through streamlined acquisitions and the integration of analysis platforms, enhancing efficiency.…”

Section: See Article By Patel Et Almentioning

confidence: 99%

Advancements in CT Tissue Characterization: Myocardial Insights in Aortic Stenosis and Amyloidosis

Gräni

2024

Circ: Cardiovascular Imaging

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Extracellular Volume Fraction by Computed Tomography Predicts Long-Term Prognosis Among Patients With Cardiac Amyloidosis

Cited by 22 publications

References 40 publications

Cardiac Imaging Biomarkers in Chronic Kidney Disease

Cardiac Imaging Biomarkers in Chronic Kidney Disease

Clinical characteristics of patients with high extracellular volume fraction evaluated by cardiac computed tomography for coronary artery evaluation

Advancements in CT Tissue Characterization: Myocardial Insights in Aortic Stenosis and Amyloidosis

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