Key result
Myocardial ECV ≥32.7% on CT is linked to a ~5.6-fold higher MACE risk in DCM.
Why the study?
Screening for coronary artery disease and other cardiomyopathies is necessary for diagnosis of DCM, and the utility of ECV analysis by cardiac CT to predict prognosis in DCM was evaluated.
Does extracellular volume fraction (ECV) analysis by cardiac CT predict major adverse cardiac events (MACE) in patients with dilated cardiomyopathy?
Cohort (n=70)
No
Does extracellular volume fraction (ECV) analysis by cardiac CT predict major adverse cardiac events (MACE) in patients with dilated cardiomyopathy?
Hazard Ratio: 5.62 (95% CI 1.2–26.3)
p-value: p=0.028
Extracellular volume fraction (ECV) analysis by cardiac CT is an independent predictor of major adverse cardiac events in patients with dilated cardiomyopathy.
CT-ECV by cardiac CT may refine DCM prognosis; leaves open incremental value over standard markers in prospective studies.
Purpose: Dilated cardiomyopathy (DCM) is commonly encountered in daily clinical practice, and screening for coronary artery disease and other cardiomyopathies is necessary for its diagnosis. Cardiac CT is useful for the screening of coronary artery stenosis, and extracellular volume fraction (ECV) analysis by CT has become available using new specific software. Here, we evaluated the utility of ECV analysis using cardiac CT to predict patient prognosis in cases with DCM. Methods: We analyzed 70 cases with DCM and coronary computed tomography (CT) with available late-phase images. We evaluated the ECV of the left ventricular myocardium (LVM) using commercially available software (Ziostation 2, Ziosoft Inc, Japan). Results: ECV on LVM was 34.5±4.9%. Major adverse cardiac events (MACE) occurred in 20 cases (29%). ECV of the LVM on CT and the presence of significant valvular disease were significantly higher in cases with MACE than in those without (37.6±5.9 vs 33.2±3.9% and 55% vs 24%, P=0.0057 and P=0.013). LVEF was significantly lower in cases with MACE than in those without (22.3±7.6 vs 30.8±11.8%, P=0.0008). The best cut-off value of ECV on LVM for prediction of MACE was 32.7% based on receiver operating characteristics analysis. Cases with ECV ≥32.7% had significantly higher MACE based on Kaplan-Meier analysis (P=0.012). Only ECV on LVM was an independent predictor of MACE based on a Cox proportional hazards model (P=0.028). Conclusion: Evaluation of ECV on LVM by CT is useful for predicting MACE in patients with DCM.
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Yashima et al. (2021) conducted a cohort in Dilated cardiomyopathy (n=70). Extracellular volume fraction (ECV) ≥ 32.7% on CT vs. ECV < 32.7% was evaluated on Major adverse cardiac events (MACE) (HR 5.62, 95% CI 1.20-26.3, p=0.028). An extracellular volume fraction of the left ventricular myocardium ≥ 32.7% measured by computed tomography independently predicted major adverse cardiac events in patients with dilated cardiomyopathy (HR 5.62).
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