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Kato S, Misumi Y, Horita N, Yamamoto K, Utsunomiya D. Clinical Utility of Computed Tomography-Derived Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2024; 17:516-528. [PMID: 37999657 DOI: 10.1016/j.jcmg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 09/06/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Computed tomography (CT)-derived extracellular volume fraction (ECV) is a noninvasive method to quantify myocardial fibrosis. Although studies suggest CT is a suitable measure of ECV, clinical use remains limited. OBJECTIVES A meta-analysis was performed to determine the clinical value of CT-derived ECV in cardiovascular diseases. METHODS Electronic database searches of PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE were performed. The most pivotal analysis entailed the comparison of ECV ascertained through CT-ECV among the control, aortic stenosis, and cardiac amyloidosis cohorts. The diagnostic test accuracy for detecting cardiac amyloidosis was assessed using summary receiver-operating characteristics curve. RESULTS Pooled CT-derived ECV values were 28.5% (95% CI: 27.3%-29.7%) in the control, 31.9% (95% CI: 30.2%-33.8%) in the aortic stenosis, and 48.9% (95% CI: 44.5%-53.3%) in the cardiac amyloidosis group. ECV was significantly elevated in aortic stenosis (P = 0.002) (vs controls) but further elevated in cardiac amyloidosis (P < 0.001) (vs aortic stenosis). CT-derived ECV had a high diagnostic accuracy for cardiac amyloidosis, with sensitivity of 92.8% (95% CI: 86.7%-96.2%), specificity of 84.8% (95% CI: 68.6%-93.4%), and area under the summary receiver-operating characteristic curve of 0.94 (95% CI: 0.88-1.00). CONCLUSIONS This study is the first comprehensive systematic review and meta-analysis of CT-derived ECV evaluation in cardiac disease. The high diagnostic accuracy of CT-ECV suggests the usefulness of CT-ECV in the diagnosis of cardiac amyloidosis in preoperative CT planning for transcatheter aortic valve replacement.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Yuka Misumi
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Karabinowska-Małocha A, Dziewięcka E, Banyś P, Urbańczyk-Zawadzka M, Krupiński M, Mielnik M, Łach J, Budkiewicz A, Podolec P, Żydzik Ł, Wiśniowska-Śmiałek S, Holcman K, Kostkiewicz M, Rubiś P. The Relationship between Cardiac Magnetic Resonance-Assessed Replacement and Interstitial Fibrosis and Ventricular Arrhythmias in Hypertrophic Cardiomyopathy. J Pers Med 2022; 12:294. [PMID: 35207782 PMCID: PMC8876292 DOI: 10.3390/jpm12020294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Non-sustained ventricular tachycardia (nsVT) creates the electrical basis for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We aimed to evaluate the relationship between interstitial fibrosis on cardiac magnetic resonance (CMR) and nsVT in HCM. A total of 50 HCM patients underwent CMR with a 3 T scanner to determine the presence of replacement fibrosis expressed by late gadolinium enhancement (LGE), and interstitial fibrosis expressed by native T₁, post-contrast T₁, and extracellular volume (ECV). The incidence of nsVT was assessed by Holter monitoring. We detected nsVT in 14 (28%) out of 50 HCM patients. Replacement fibrosis expressed by LGE was present in 37 (74%) patients and only showed a trend towards a differentiation between the groups with and without nsVT (p = 0.07). However, the extent of LGE was clearly higher in the nsVT group (3.8 ± 4.9% vs. 7.94 ± 4.5%, p = 0.002) and was an independent predictor of nsVT in a multivariable regression analysis (OR 1.2; 95%CI 1.02-1.4; p = 0.02). No relationship was observed between interstitial fibrosis and nsVT. To conclude, it was found that it is not the mere presence but the actual extent of LGE that determines the occurrence of nsVT in HCM patients; the role of interstitial fibrosis remains unclear.
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Affiliation(s)
- Aleksandra Karabinowska-Małocha
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Paweł Banyś
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Małgorzata Urbańczyk-Zawadzka
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Maciej Krupiński
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Małgorzata Mielnik
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Jacek Łach
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Aleksandra Budkiewicz
- Students’ Scientific Group on Heart Failure, at the Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (A.B.); (Ł.Ż.)
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Łukasz Żydzik
- Students’ Scientific Group on Heart Failure, at the Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (A.B.); (Ł.Ż.)
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
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