Key result
Higher CT-derived LV ECV is linked to elevated BNP and poorer post-ablation LVEF recovery.
Why the study?
The prognostic and diagnostic significance of CT-derived left ventricular extracellular volume fraction (ECV), a marker of diffuse left ventricular fibrosis, remained unclear in patients with AF undergoing catheter ablation.
Does CT-derived left ventricular extracellular volume fraction predict heart failure surrogate markers and post-ablation LVEF improvement in patients with atrial fibrillation undergoing catheter ablation?
Cohort (n=423)
Does CT-derived left ventricular extracellular volume fraction predict heart failure surrogate markers and post-ablation LVEF improvement in patients with atrial fibrillation undergoing catheter ablation?
Routine CT-derived left ventricular extracellular volume fraction correlates with heart failure markers and inversely predicts LVEF recovery following catheter ablation in atrial fibrillation patients with reduced LVEF.
CT-derived ECV was associated with elevated BNP and less LVEF recovery after AF ablation; hypothesis-generating for risk stratification, requires validation.
Background Heart failure (HF) is one of the important events in patients with atrial fibrillation (AF). However, the prognostic and diagnostic significance of computed tomography (CT)-derived left ventricular extracellular volume fraction (ECV), which reflects diffuse left ventricular fibrosis, remains unclear. Purpose To evaluate whether ECV is associated with surrogate markers of HF (B-type natriuretic peptide (BNP), left atrial volume index, and tissue Doppler-derived E/e’ ratio) and whether it predicts post-ablation improvement in left ventricular ejection fraction (LVEF) in patients with AF. Methods We conducted a cohort study, including 423 consecutive patients (median age: 73 years; 70% male; 53% with paroxysmal AF; mean LVEF: 59 ± 11%) scheduled for catheter ablation. Left ventricular ECV was measured using routine contrast-enhanced CT. Results The mean ECV was 29.1 ± 5.9%, and baseline BNP levels were 90.7 [40.1–174.4] pg/mL. High ECV, defined as > 35%, was observed in 15% of patients. ECV was significantly associated with log-transformed BNP, left atrial volume index, and E/e’ ratio (r = 0.463, p < 0.001; r = 0.324, p < 0.001; and r = 0.255, p < 0.001, respectively; Figure). Multivariable logistic regression analysis revealed that ECV was independently associated with BNP > 100 pg/mL after adjustment for age, sex, AF phenotype, and LVEF (odds ratio = 1.14, 95% CI: 1.09–1.20 per 1% increase in ECV, p < 0.001). Furthermore, in a subgroup of 32 patients with non-ischemic dilated cardiomyopathy (LVEF < 50%), LVEF improved from 37.4 ± 7.6% to 55.8 ± 11.9% at 6 months after ablation (ΔLVEF: 18.4 ± 11.7%). A significant inverse correlation was observed between ECV and ΔLVEF (r = -0.561, p < 0.001; Figure). Conclusions CT-derived left ventricular ECV was feasible to measure, correlated with established markers of heart failure, and predicted improvement in LVEF after catheter ablation.
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Yamada et al. (2026) conducted a cohort in Atrial fibrillation (n=423). CT-derived left ventricular extracellular volume fraction (ECV) was evaluated on Association with BNP > 100 pg/mL and post-ablation change in LVEF (ΔLVEF) (OR 1.14 per 1% increase in ECV, 95% CI 1.09-1.20, p=<0.001). CT-derived LV ECV was independently associated with BNP >100 pg/mL (OR 1.14 per 1% increase, 95% CI 1.09–1.20) and inversely correlated with post-ablation LVEF improvement (r=-0.561, p<0.001).
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