What does this research mean for the field?

Elevated preprocedural CT-ECV% predicts lesser LVEF recovery and higher BNP levels post-TAVI, indicating ongoing myocardial fibrosis. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study investigates how elevated CT-derived extracellular volume (ECV) predicts left ventricular (LV) outcomes post TAVI.

February 8, 2026

Elevated preprocedural CT-ECV predicts residual LV morphological and functional impairment after TAVI

Key Result

Elevated pre-TAVI CT-ECV >30.44% predicted higher BNP (206.5 pg/mL), lower LVEF (62.6%), and increased LV mass index at 1 month, indicating impaired LV recovery.

Key Points

This study investigates how elevated CT-derived extracellular volume (ECV) predicts left ventricular (LV) outcomes post TAVI.
Enrolled patients undergoing TAVI from March 2023 to November 2024.
Measured CT-ECV before and one month after TAVI as part of routine imaging.
Divided cohort into tertiles based on baseline ECV% for analysis.
195 of 217 patients completed one-month follow-up.
Higher ECV% associated with increased BNP levels across tertiles (p < 0.0001).
LVEF decreased and LV mass index increased with rising ECV% (both p < 0.0001).
No significant effect was observed on global longitudinal strain with increasing ECV%.
Population with higher baseline ECV% maintained elevated levels post TAVI (p = 0.009).

Structured PICO

Does elevated preprocedural CT-ECV predict residual LV morphological and functional impairment after TAVI in patients with severe aortic stenosis?

Population

217 patients with severe aortic stenosis who underwent TAVI (195 completed one-month follow-up)

Intervention

Preprocedural CT-derived myocardial extracellular volume (CT-ECV) measurement, stratified by tertiles (<26.52%, 26.52% - 30.44%, >30.44%)

Comparator

Comparison across baseline ECV% tertiles

Outcome

Markers of left ventricular decompensation (BNP levels, LVEF, LV mass index, GLS, and ECV%) at one month after TAVIsurrogate

Elevated preprocedural CT-ECV in severe aortic stenosis patients undergoing TAVI is associated with limited LVEF recovery, higher BNP, and persistent myocardial fibrosis at one month.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Elevated computed tomography-derived myocardial extracellular volume (CT-ECV) levels reflect the extent of myocardial fibrosis and are associated with adverse cardiac events after transcatheter aortic valve implantation (TAVI). Consequently, incorporating CT-ECV evaluation into TAVI planning may provide valuable prognostic information for risk stratification. This study aims to explore the relationship between CT-ECV and markers of left ventricular decompensation, contributing to a better understanding of its clinical implications in aortic stenosis management. Methods From March 2023 to November 2024, we enrolled patients who underwent TAVI in our institution. CT-ECV was measured as part of routine CT imaging before and one month after TAVI. To explore associations between ECV% and clinical variables, the cohort was divided into tertiles based on the baseline ECV% values: tertile 1 (26.52%), tertile 2 (26.52% - 30.44%), and tertile 3 (30.44%). Results Of the 217 TAVI patients, 195 completed one-month follow-up. The mean ECV% at baseline was 28.72 ± 4.25%. At one-month after TAVI, a stepwise increase in BNP levels was found across tertiles (69.4 43.7 - 115.2 pg/mL in tertile 1, 131.1 80.6 - 227.3 pg/mL in tertile 2, and 206.5 94.4 - 284.8 pg/mL in tertile 3, p 0.0001). Consistently, left ventricular ejection fraction (LVEF) showed a decreasing trend (70.4% 65.9 -73.5 in tertile 1, 69.2% 63.5 - 73.1 in tertile 2, and 62.6% 55.8 - 68.1 in tertile 3, p 0.0001). In addition, left ventricular mass index (LV mass index) showed an increasing trend (108.7 93.4 -125.9 g/m2 in tertile 1, 113.5 91.6 – 134.8 g/m2 in tertile 2, and 125.8 114.6 – 141.3 g/m2 in tertile 3, p = 0.003). A non-significant impairment in global longitudinal strain (GLS) was found as the ECV% increases (16.5% 14.1 -18.1 in tertile 1, 16.2% 13.4 – 18.7 in tertile 2, and 15.4% 13.2 – 17.6 in tertile 3, p = 0.487). Patients with higher baseline ECV% remained elevated at one-month after TAVI (28.24% 25.19 - 30.98 in tertile 1, 29.25% 25.93 - 33.31 in tertile 2, and 31.36% 27.87 - 34.33 in tertile 3, p = 0.009). Conclusions In patients with severe aortic stenosis undergoing TAVI, elevated preprocedural ECV% was associated with limited LVEF recovery, continuous elevation in BNP levels, and persistent myocardial fibrosis, suggesting the need for intensive pharmacological management following TAVI.

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