Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis

• Published in: PloS one Vol. 16; no. 3; p. e0248306
• Main Authors: Hammer, Yoav, Talmor-Barkan, Yeela, Abelow, Aryeh, Orvin, Katia, Aviv, Yaron, Bar, Noam, Levi, Amos, Landes, Uri, Shafir, Gideon, Barsheshet, Alon, Vaknin-Assa, Hana, Sagie, Alexander, Kornowski, Ran, Hamdan, Ashraf
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.03.2021; Public Library of Science (PLoS)
• Subjects: Amyloidosis; Aorta; Aortic stenosis; Aortic valve; Aortic valve stenosis; Applications of mathematics; Applied mathematics; Auroral kilometric radiation; Biology and Life Sciences; Cardiology; Cardiovascular disease; Cardiovascular diseases; Computed tomography; Computer science; Coronary vessels; CT imaging; Damage assessment; Data analysis; Drug dosages; Editing; Electronic mail; Fibrosis; Health care facilities; Heart failure; Heart rate; Heart valves; Hospitals; Low flow; Magnetic resonance imaging; Mathematical analysis; Medical imaging; Medicine; Medicine and Health Sciences; Methodology; Parameters; Patient outcomes; Patients; Physiological aspects; Prognosis; Radiation; Radiation dosage; Research and Analysis Methods; Stenosis; Supervision; Israel; Tel Aviv Israel
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248306

The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65-0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.