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Purpose <p>To validate the feasibility of using late iodine enhancement (LIE)-derived ECV on iodine density images using spectral detector computed tomography (SDCT; CT-ECV) and to assess the potential of CT-ECV for risk stratification among patients with non-ischemic heart failure (NIHF).</p> Materials and methods <p>Forty-five subjects who underwent cardiac SDCT and CMR were included in the validation group to calculate and compare CT-ECV with CMR-ECV to validate CT-ECV feasibility. Another 117 subjects (82 patients with NIHF, 35 controls) who underwent SDCT were included in the experimental group to explore the potential of CT-ECV for risk stratification. ECV was measured via iodine density images and CMR T1 mapping in accordance with American Heart Association 16-segment models.</p> Results <p>In the validation group, there was no significant difference between CT-ECV and CMR-ECV (<i>P</i> = 0.293), with an insignificant bias. In the experimental group, CT-ECV in patients with NIHF was significantly higher than in controls (<i>P</i> &lt; 0.05). In 82 patients with NIHF, CT-ECV in HFrEF ( HF with reduced ejection fraction: LVEF ≤ 40%) patients was statistically higher than that of HFmEF (HF with mildly reduced ejection fraction: LVEF 41–49%) and HFpEF (HF with preserved ejection fraction: LVEF ≥ 50%) patients (<i>P</i> &lt; 0.05) and a significant difference among patients with NIHF with varied New York Heart Association classes (all <i>P</i> &lt; 0.05); In addition, Kaplan–Meier survival curves and Log-rank test demonstrated that NIHF patients with CT-ECV ≥ 31.29% had higher probability of MACE than NIHF patients with CT-ECV &lt; 31.29% (<i>P</i> &lt; 0.001).</p> Conclusion <p>LIE-derived CT-ECV on iodine density images using SDCT is a promising practical alternative to CMR-ECV, with the potential to assist with risk stratification among patients with NIHF.</p> Graphical abstract <p>In the assessment of non-ischemic heart failure, inclusion of late iodine enhancement to obtain ECV in CCTA examination may play a valuable role in future risk assessment in this clinical setting.</p>

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Myocardial extracellular volume fraction with spectral detector computed tomography for risk stratification in non-ischemic heart failure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月30日

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  • Jie Deng,
  • Yu Wang,
  • Tianfu Qi,
  • Zhiming Li,
  • Hongen Zheng,
  • Yan Wu,
  • Lin Lu,
  • Deyan Li,
  • Dan Han,
  • Wei Chen

摘要

Purpose

To validate the feasibility of using late iodine enhancement (LIE)-derived ECV on iodine density images using spectral detector computed tomography (SDCT; CT-ECV) and to assess the potential of CT-ECV for risk stratification among patients with non-ischemic heart failure (NIHF).

Materials and methods

Forty-five subjects who underwent cardiac SDCT and CMR were included in the validation group to calculate and compare CT-ECV with CMR-ECV to validate CT-ECV feasibility. Another 117 subjects (82 patients with NIHF, 35 controls) who underwent SDCT were included in the experimental group to explore the potential of CT-ECV for risk stratification. ECV was measured via iodine density images and CMR T1 mapping in accordance with American Heart Association 16-segment models.

Results

In the validation group, there was no significant difference between CT-ECV and CMR-ECV (P = 0.293), with an insignificant bias. In the experimental group, CT-ECV in patients with NIHF was significantly higher than in controls (P < 0.05). In 82 patients with NIHF, CT-ECV in HFrEF ( HF with reduced ejection fraction: LVEF ≤ 40%) patients was statistically higher than that of HFmEF (HF with mildly reduced ejection fraction: LVEF 41–49%) and HFpEF (HF with preserved ejection fraction: LVEF ≥ 50%) patients (P < 0.05) and a significant difference among patients with NIHF with varied New York Heart Association classes (all P < 0.05); In addition, Kaplan–Meier survival curves and Log-rank test demonstrated that NIHF patients with CT-ECV ≥ 31.29% had higher probability of MACE than NIHF patients with CT-ECV < 31.29% (P < 0.001).

Conclusion

LIE-derived CT-ECV on iodine density images using SDCT is a promising practical alternative to CMR-ECV, with the potential to assist with risk stratification among patients with NIHF.

Graphical abstract

In the assessment of non-ischemic heart failure, inclusion of late iodine enhancement to obtain ECV in CCTA examination may play a valuable role in future risk assessment in this clinical setting.