CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis
Introduction: Prior to transcutaneous aortic valve replacement (TAVR), a CT is performed (TAVR-CT). With modification, the CT exam can measure myocardial extracellular volume (ECV). A small increase in ECV occurs in severe aortic stenosis. A large increase in ECV occurs when transthyretin cardiac am...
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| Language: | English |
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Elsevier
2025-08-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000783 |
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| author | Joshua N. McShane Anahita Tavoosi Huda El Mais Keren Mbondo Kasuku Anthony Poulin Mehmet Onur Omaygenc Ian G. Burwash David Messika-Zeitoun Benjamin J.W. Chow Gary R. Small |
| author_facet | Joshua N. McShane Anahita Tavoosi Huda El Mais Keren Mbondo Kasuku Anthony Poulin Mehmet Onur Omaygenc Ian G. Burwash David Messika-Zeitoun Benjamin J.W. Chow Gary R. Small |
| author_sort | Joshua N. McShane |
| collection | DOAJ |
| description | Introduction: Prior to transcutaneous aortic valve replacement (TAVR), a CT is performed (TAVR-CT). With modification, the CT exam can measure myocardial extracellular volume (ECV). A small increase in ECV occurs in severe aortic stenosis. A large increase in ECV occurs when transthyretin cardiac amyloidosis (ATTR-CA) co-exists. We sought to determine the prognostic potential of ECV in severe aortic stenosis and test the utility of threshold ECV to instigate screening for ATTR-CA. Methods: This was a prospective observation study of consecutive severe AS patients undergoing CT -TAVR. A delayed cardiac acquisition was acquired 5 min post TAVR-CT. Pre-contrast and delayed -images were used to determine ECV. When ECV ≥ 31 % 99mTc-pyrophosphate (PYP) imaging was performed. The primary end point was all cause mortality. Results: During the study, 161 patients underwent aortic valve replacement and were included in the analysis. Mean age was 81.6 (±6.2) years. During median follow up of 29 (21–36) months, 24 deaths occurred.In 30 patients ECV ≥ 31 %, 2 had positive 99mTc-PYP imaging for ATTR-CA. On Cox regression analysis increased ECV associated with increased risk of all cause mortality (HR 2.54 (95 % CI 1.09–5.93) and was incremental to age, LV function and renal impairment (p = 0.03). Conclusion: In severe AS, elevated ECV was a risk for all cause mortality, but this was not related to co-existent ATTR-CA. Threshold-ECV testing for ATTR-CA demonstrated a low yield. Threshold testing may therefore not be warranted in all severe AS patients with an ECV ≥ 31 %. |
| format | Article |
| id | doaj-art-6d513f774ee94d4e9219f6fe5a90fc35 |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-6d513f774ee94d4e9219f6fe5a90fc352025-08-20T03:50:50ZengElsevierAmerican Heart Journal Plus2666-60222025-08-015610057510.1016/j.ahjo.2025.100575CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosisJoshua N. McShane0Anahita Tavoosi1Huda El Mais2Keren Mbondo Kasuku3Anthony Poulin4Mehmet Onur Omaygenc5Ian G. Burwash6David Messika-Zeitoun7Benjamin J.W. Chow8Gary R. Small9Division of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDepartments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, 2725 Chemin Ste-FOY, Quebec City, Quebec G1V 4G5, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, CanadaDivision of Cardiology, Department of medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Corresponding author at: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.Introduction: Prior to transcutaneous aortic valve replacement (TAVR), a CT is performed (TAVR-CT). With modification, the CT exam can measure myocardial extracellular volume (ECV). A small increase in ECV occurs in severe aortic stenosis. A large increase in ECV occurs when transthyretin cardiac amyloidosis (ATTR-CA) co-exists. We sought to determine the prognostic potential of ECV in severe aortic stenosis and test the utility of threshold ECV to instigate screening for ATTR-CA. Methods: This was a prospective observation study of consecutive severe AS patients undergoing CT -TAVR. A delayed cardiac acquisition was acquired 5 min post TAVR-CT. Pre-contrast and delayed -images were used to determine ECV. When ECV ≥ 31 % 99mTc-pyrophosphate (PYP) imaging was performed. The primary end point was all cause mortality. Results: During the study, 161 patients underwent aortic valve replacement and were included in the analysis. Mean age was 81.6 (±6.2) years. During median follow up of 29 (21–36) months, 24 deaths occurred.In 30 patients ECV ≥ 31 %, 2 had positive 99mTc-PYP imaging for ATTR-CA. On Cox regression analysis increased ECV associated with increased risk of all cause mortality (HR 2.54 (95 % CI 1.09–5.93) and was incremental to age, LV function and renal impairment (p = 0.03). Conclusion: In severe AS, elevated ECV was a risk for all cause mortality, but this was not related to co-existent ATTR-CA. Threshold-ECV testing for ATTR-CA demonstrated a low yield. Threshold testing may therefore not be warranted in all severe AS patients with an ECV ≥ 31 %.http://www.sciencedirect.com/science/article/pii/S2666602225000783Aortic stenosisMyocardial extracellular volumeTransthyretin cardiac amyloidosis |
| spellingShingle | Joshua N. McShane Anahita Tavoosi Huda El Mais Keren Mbondo Kasuku Anthony Poulin Mehmet Onur Omaygenc Ian G. Burwash David Messika-Zeitoun Benjamin J.W. Chow Gary R. Small CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis American Heart Journal Plus Aortic stenosis Myocardial extracellular volume Transthyretin cardiac amyloidosis |
| title | CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis |
| title_full | CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis |
| title_fullStr | CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis |
| title_full_unstemmed | CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis |
| title_short | CT derived ECV in severe aortic stenosis: prognosticator and screening test for co-existent transthyretin cardiac amyloidosis |
| title_sort | ct derived ecv in severe aortic stenosis prognosticator and screening test for co existent transthyretin cardiac amyloidosis |
| topic | Aortic stenosis Myocardial extracellular volume Transthyretin cardiac amyloidosis |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000783 |
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