Key result
CT-derived ECV is significantly higher in cardiac pathology compared to healthy controls.
Why the study?
While cardiac MRI is the gold standard for myocardial ECV assessment, CT offers an alternative for patients with contraindications; this study aimed to determine if CT-derived ECV is systematically elevated in cardiac diseases linked to myocardial fibrosis.
Is CT-derived extracellular volume (ECV) systematically elevated in cardiac diseases associated with myocardial fibrosis compared to controls?
Meta-Analysis (n=1,129)
Is CT-derived extracellular volume (ECV) systematically elevated in cardiac diseases associated with myocardial fibrosis compared to controls?
Standardized Mean Difference: 1.6 (95% CI 1.23–1.96)
CT-derived ECV is a reliable non-invasive marker of myocardial fibrosis that is significantly elevated in pathological cardiac conditions.
Supports CT-derived ECV as fibrosis biomarker; extends CMR validation to CT across cardiac disease cohorts.
Background/Objectives: Extracellular volume (ECV) of the myocardium, a biomarker of interstitial space and fibrosis, plays a critical role in cardiac disease diagnosis and prognosis. Although cardiac magnetic resonance imaging (MRI) is the gold standard for ECV assessment, computed tomography (CT) offers a viable alternative, particularly in patients with contraindications to MRI. This study aimed to assess whether CT-derived ECV is systematically elevated in cardiac diseases associated with myocardial fibrosis. Methods: A systematic search of PubMed and Web of Science up to January 2023 identified 364 studies, including 16 from registers and 4 from manual searches. After exclusions, 73 studies were included in the systematic review. Of these, 15 provided quantitative data on group sizes, mean ECV values, standard deviations, and imaging modalities (CTA, DECT, LIE-DECT) and were analyzed in the meta-analysis. Standardized mean differences (SMD) were calculated using Cochrane Handbook formulas. Statistical analyses employed random-effects models (R version 4.4.2). Results: The pooled analysis showed that ECV was significantly higher in pathological groups compared to controls (SMD 1.60; 95% CI: 1.23–1.96; I2 = 84.6%). Elevated ECV correlated with worse clinical outcomes, including higher mortality in heart failure and advanced myocardial fibrosis in amyloidosis and cardiomyopathies. Subgroup analyses demonstrated that advanced CT techniques (DECT, LIE-DECT) and CTA provided comparable diagnostic accuracy. Conclusions: CT-derived ECV is a reliable, non-invasive marker of myocardial fibrosis, offering diagnostic and prognostic value similar to MRI. Standardizing CT protocols and conducting multicenter studies are essential to validate its broader clinical application.
No takes yet. Share an insight, caveat, or question.
Martuszewski et al. (2025) conducted a meta-analysis in Cardiac diseases associated with myocardial fibrosis (n=1,129). Pathological cardiac conditions vs. Controls was evaluated on Standardized mean difference in CT-derived ECV (SMD 1.60, 95% CI 1.23-1.96). CT-derived extracellular volume was significantly higher in pathological groups compared to controls (SMD 1.60).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: