Prognostic value of myocardial computed tomography-derived extracellular volume in severe aortic stenosis requiring aortic valve replacement: A Systematic Review and Meta-analysis
Year: 2025
Type: review
Abstract: AIM: Computed tomography (CT)-derived extracellular volume fraction (ECV) is a non-invasive method to quantify myocardial fibrosis. Evaluating CT-ECV during aortic valve replacement (AVR) planning CT in severe aortic stenosis (AS) may aid prognostic stratification. This meta-analysis evaluated the prognostic significance of CT-ECV in severe AS necessitating AVR. METHODS AND RESULTS: Electronic database searches of PubMed, OVID-MEDLINE, and Cochrane Library were performed. The primary outcome was to compare the occurrence of a composite of cardiovascular outcomes in patients with severe AS undergoing AVR with elevated myocardial CT-ECV values versus patients with normal values. Secondary outcomes included all-cause mortality and heart failure (HF) related hospitalization. A total of 1223 patients undergoing AVR for severe AS were included in 10 studies: 524 patients with high values of CT-ECV and 699 with normal values of CT-ECV. The pooled CT-ECV cut-off to define elevated values and predict prognosis was 30.7% (95% CI: 28.5-33.7%). At a mean follow-up of 17.9±2.3 months after AVR, patients with elevated CT-ECV experienced a significantly higher number of cardiovascular events (43.4% vs 14.0%; OR:4.3, 95% CI:3.192/5.764, p <0.001). Regarding secondary outcomes, all-cause mortality occurred in 29.3% of patients with elevated CT-ECV vs 11.6% with CT-ECV below the cut-off (OR3.5, 95% CI:2.276/5.311, p<0.001), whereas HF hospitalization was observed in 25.5% vs 5.9% (OR 4.9, 95% CI: 2.283/10.376, p<0.001). Graphical Abstract. CONCLUSION: Patients undergoing AVR for severe AS with elevated CT-ECV values experience a worse post-intervention prognosis. The implementation of CT-ECV evaluation in routine AVR planning protocols should be considered.
Authors: Faggiano, Andrea, Gherbesi, Elisa, Carugo, Stefano, Brusamolino, Matteo, Cozac, Dan Alexandru, Cozza, Elena, Savo, Maria Teresa, Cannata, Francesco, Guglielmo, Marco, La Mura, Lucia, Fazzari, Fabio, Carrabba, Nazario, Conte, Edoardo, Mushtaq, Saima, Baggiano, Andrea, Guaricci, Andrea I, Pedrinelli, Roberto, Indolfi, Ciro, Sinagra, Gianfranco, Perrone Filardi, Pasquale, Pergola, Valeria, Pontone, Gianluca, Team Medisch, Circulatory Health
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7074215652
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