What is the clinical evidence from this study?

Study design: Cohort. Population: Severe heart failure requiring cardiac resynchronization therapy (n=52). Intervention: Left ventricular extracellular volume (LVECV) on computed tomography. Primary outcome: Cardiac death, hospitalization for HF, and fatal arrhythmia after CRT device implantation (HR 3.21, 95% CI 1.08-9.51, p=0.04).

What does this research mean for the field?

Left ventricular extracellular volume measured by computed tomography significantly predicts cardiac death, heart failure hospitalization, or fatal arrhythmia following cardiac resynchronization therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the utility of left ventricular extracellular volume on computed tomography for predicting prognosis in cardiac resynchronization therapy candidates.

April 12, 2026Open Access

Left ventricular extracellular volume on computed tomography is significant predictor of patient prognosis after cardiac resynchronization therapy

KSKatsuya SuzukiChiba University HTHiroyuki Takaoka RIRyosuke IrieChiba University Hospital

Key Result

Left ventricular extracellular volume on CT significantly predicted cardiac death, heart failure hospitalization, or fatal arrhythmia after CRT (HR 3.21; 95% CI 1.08-9.51; p=0.04).

Key Points

To evaluate the utility of left ventricular extracellular volume on computed tomography for predicting prognosis in cardiac resynchronization therapy candidates.
Included 52 patients undergoing cardiac CT before CRT device implantation.
Measured primary outcomes: cardiac death, hospitalization for heart failure, and fatal arrhythmia post-CRT.
Defined CRT responders by a 15% or greater reduction in left ventricular end-systolic volume.
Utilized receiver operating characteristic analysis to identify optimal LVECV threshold.
Applied Cox proportional hazards model to assess prediction of primary outcomes.
37% of patients experienced one primary outcome (7 cardiac deaths, 7 fatal arrhythmias, 5 hospitalizations).
LVECV was significantly lower in CRT responders compared to non-responders (36% vs 40%, p = 0.03).
LVECV was higher in patients with one of the primary outcomes (42% vs 35%, p < 0.001).
Identified 44.03% as the optimal LVECV threshold for predicting outcomes.
Kaplan-Meier analysis showed more primary events in patients with LVECV ≥ 44.03% (p < 0.01).

Study Design

Type

Cohort (n=52)

Structured PICO

Does left ventricular extracellular volume on computed tomography predict prognosis and response in patients undergoing cardiac resynchronization therapy?

Population

52 patients with severe heart failure who underwent cardiac computed tomography (CT) before cardiac resynchronization therapy (CRT) device implantation between 2008 and 2024.

Intervention

Left ventricular extracellular volume (LVECV) measurement on cardiac computed tomography (CT) prior to CRT implantation.

Comparator

Patients with lower LVECV (specifically evaluated at an optimal threshold of 44.03%).

Outcome

Composite of cardiac death, hospitalization for HF, and fatal arrhythmia after CRT device implantation.composite

Left ventricular extracellular volume assessed by cardiac CT prior to CRT implantation is a significant predictor of clinical outcomes and CRT response in patients with severe heart failure.

Main Result

Effect estimate: HR 3.21 (95% CI 1.08-9.51)

p-value: p=0.04

Abstract

Background: Cardiac resynchronization therapy (CRT) is useful for patients with severe heart failure (HF); however, almost 30% of patients are non-responders.Purpose: This study aimed to evaluate the utility of left ventricular (LV) extracellular volume (ECV) on computed tomography (CT) for the prediction of prognosis in CRT candidates.Methods: This study included 52 patients who underwent cardiac CT before CRT device implantation between 2008 and 2024.The primary outcomes were cardiac death, hospitalization for HF, and fatal arrhythmia after CRT device implantation.CRT responders were defined as patients who exhibited a 15% or greater reduction in LV end-systolic volume.Results: Nineteen patients (37%) experienced one of the primary outcomes (7 cardiac deaths, 7 fatal arrhythmias, and 5 H F hospitalizations).LVECV was lower in CRT responders (n = 26) than in the others (n = 23) (36% 7.6% vs 40% 6.0%, p = 0.03).LVECV was higher in patients with one of the primary outcomes (n = 19) than the others (n = 33) (42% 7.5% vs 35% 5.7%, p < 0.001).Receiver operating characteristic analysis identified 44.03% as the optimal LVECV threshold for predicting primary outcomes.In the Cox proportional hazards model, LVECV was a significant predictor of a primary outcome (hazard ratio, 3.21; 95% confidence interval, 1.08-9.51;p = 0.04).Kaplan-Meier analysis showed that patients with an LVECV 44.03% had significantly more primary events than those with lower LVECV (p < 0.01).Conclusion: LVECV on cardiac CT may be useful for predicting CRT response and prognosis.

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