Key result
Photon-counting detector CT links cardiac amyloidosis in severe AS to ~23 percentage points higher ECV.
Why the study?
Diffuse myocardial fibrosis and altered deformation are prognostic in aortic stenosis, but the relationship between myocardial strain and extracellular volume using photon-counting detector CT was unexplored.
Does photon-counting detector CT-derived extracellular volume and myocardial strain identify concomitant cardiac amyloidosis or reduced myocardial contractility in patients with severe aortic stenosis?
Observational (n=77)
No
Does photon-counting detector CT-derived extracellular volume and myocardial strain identify concomitant cardiac amyloidosis or reduced myocardial contractility in patients with severe aortic stenosis?
Absolute Event Rate: 48.2% vs 25.5%
p-value: p=0.048
PCD-CT-derived extracellular volume and myocardial strain measurements can non-invasively detect co-existing cardiac amyloidosis and prior myocardial damage in severe aortic stenosis patients during routine TAVR planning.
May support non-invasive amyloid detection during TAVR planning CT; extends prior CT-ECV data but remains hypothesis-generating.
Background/Objectives: Diffuse myocardial fibrosis and altered deformation are relevant prognostic factors in aortic stenosis (AS) patients. The aim of this exploratory study was to investigate the relationship between myocardial strain, and myocardial extracellular volume (ECV) in patients with severe AS with a photon-counting detector (PCD)-CT. Methods: We retrospectively included 77 patients with severe AS undergoing PCD-CT imaging for transcatheter aortic valve replacement (TAVR) planning between January 2022 and May 2024 with a protocol including a non-contrast cardiac scan, an ECG-gated helical coronary CT angiography (CCTA), and a cardiac late enhancement scan. Myocardial strain was assessed with feature tracking from CCTA and ECV was calculated from spectral cardiac late enhancement scans. Results: Patients with cardiac amyloidosis (n = 4) exhibited significantly higher median mid-myocardial ECV (48.2% versus 25.5%, p = 0.048) but no significant differences in strain values (p > 0.05). Patients with prior myocardial infarction (n = 6) had reduced median global longitudinal strain values (−9.1% versus −21.7%, p < 0.001) but no significant differences in global mid-myocardial ECV (p > 0.05). Significant correlations were identified between the global longitudinal, circumferential, and radial strains and the CT-derived left ventricular ejection fraction (EF) (all, p < 0.001). Patients with low-flow, low-gradient AS and reduced EF exhibited lower median global longitudinal strain values compared with those with high-gradient AS (−15.2% versus −25.8%, p < 0.001). In these patients, the baso-apical mid-myocardial ECV gradient correlated with GLS values (R = 0.28, p = 0.02). Conclusions: In patients undergoing PCD-CT for TAVR planning, ECV and GLS may enable us to detect patients with cardiac amyloidosis and reduced myocardial contractility
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Lisi et al. (2025) conducted an observational in Severe aortic stenosis (n=77). Photon-counting detector CT derived myocardial strain and ECV vs. Internal comparators (e.g., patients without myocardial disease) was evaluated on Mid-myocardial extracellular volume (ECV) in patients with cardiac amyloidosis versus no myocardial disease (p=0.048). Photon-counting detector CT identified significantly higher median mid-myocardial extracellular volume (48.2% vs 25.5%, p=0.048) in severe aortic stenosis patients with cardiac amyloidosis.
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