Key result
CT protocol parameters explain ~25% of CT-ECV heterogeneity, with healthy values overlapping significantly with cardiac disease.
Why the study?
There has been wide variation in cardiac CT-ECV protocols in the literature and useful disease cut-offs are yet to be established.
What are the mean CT-ECV estimates in healthy and diseased participants, and how do protocol parameters affect between-study variation?
Meta-Analysis
What are the mean CT-ECV estimates in healthy and diseased participants, and how do protocol parameters affect between-study variation?
CT-ECV estimates vary widely due to protocol differences, highlighting the need for standardization before widespread clinical implementation for diagnosis and prognosis.
Wide CT-ECV overlap limits diagnostic use; leaves open the need for protocol standardization before clinical adoption.
BACKGROUND: Cardiac computed tomography quantification of extracellular volume fraction (CT-ECV) is an emerging biomarker of myocardial fibrosis which has demonstrated high reproducibility, diagnostic and prognostic utility. However, there has been wide variation in the CT-ECV protocol in the literature and useful disease cut-offs are yet to be established. The objectives of this meta-analysis were to describe mean CT-ECV estimates and to estimate the effect of CT-ECV protocol parameters on between-study variation. METHODS: We conducted a meta-analysis of studies assessing CT-ECV in healthy and diseased participants. We used meta-analytic methods to pool estimates of CT-ECV and performed meta-regression to identify the contribution of protocol parameters to CT-ECV heterogeneity. RESULTS: = 93%) compared to 50.2% (95%CI 46.2%-54.2%) in amyloidosis, 31.2% (28.5%-33.8%) in severe aortic stenosis and 36.9% (31.6%-42.3%) in non-ischaemic dilated cardiomyopathies. Meta-regression revealed that CT protocol parameters account for approximately 25% of the heterogeneity in CT-ECV estimates. CONCLUSION: CT-ECV estimates for healthy individuals vary widely in the literature and there is significant overlap with estimates in cardiac disease. One quarter of this heterogeneity is explained by differences in CT-ECV protocol parameters. Standardization of CT-ECV protocols is necessary for widespread implementation of CT-ECV assessment for diagnosis and prognosis.
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Muthalaly et al. (2024) conducted a meta-analysis in Healthy and diseased participants (amyloidosis, severe aortic stenosis, non-ischaemic dilated cardiomyopathies). Computed tomography-derived extracellular volume fraction (CT-ECV) was evaluated on Mean CT-ECV estimates and heterogeneity. CT protocol parameters account for approximately 25% of the heterogeneity in CT-ECV estimates, which vary widely in healthy individuals and overlap significantly with cardiac disease estimates.
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