Quantification of extracellular volume with cardiac computed tomography in patients with dilated cardiomyopathy

Andrea Baggiano, Edoardo Conte, Luigi Spiritigliozzi, Saima Mushtaq, Andrea Annoni, Maria Ludovica Carerj, Francesco Cilia, Fabio Fazzari, Alberto Formenti, Antonio Frappampina, Laura Fusini, Margherita Gaudenzi Asinelli, Daniele Junod, Maria Elisabetta Mancini, Valentina Mantegazza, Riccardo Maragna, Francesca Marchetti, Marco Penso, Luigi Tassetti, Alessandra VolpeFrancesca Baessato, Marco Guglielmo, Alexia Rossi, Chiara Rovera, Daniele Andreini, Mark G. Rabbat, Andrea Igoren Guaricci, Mauro Pepi, Gianluca Pontone*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Cardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECVCCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECVCMR as the reference technique. Methods: 39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECVCMR and ECVCCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed. Results: Mean age of enrolled patients was 62 ​± ​11 years, and mean LVEF at CMR was 35.4 ​± ​10.7%. Overall radiation exposure for ECV estimation was 2.1 ​± ​1.1 ​mSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECVCCT demonstrated slightly lower values compared to ECVCMR (all segments, 31.8 ​± ​6.5% vs 33.9 ​± ​8.0%, p ​< ​0.001). At regression analysis, strong correlations were described (all segments, r ​= ​0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECVCMR and ECVCCT for global analysis was 2.1 (95% CI: −6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECVCCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively). Conclusions: ECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.

Original languageEnglish
Pages (from-to)261-268
Number of pages8
JournalJournal of cardiovascular computed tomography
Volume17
Issue number4
DOIs
Publication statusPublished - 1 Jul 2023

Keywords

  • Cardiac computed tomography
  • Cardiovascular magnetic resonance
  • Extracellular volume
  • Left ventricle dysfunction
  • Myocardial fibrosis

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