Prognostic value of early myocardial extracellular volume assessment in survival of aortic dissection

Background To investigate the prognostic value of early myocardial extracellular volume (ECV) derived from routine arterial phase computed tomography angiography (CTA) imaging in patients with aortic dissection. Methods CTA examinations between 2018 and 2022 were retrospectively reviewed and grouped with regards to the presence of aortic dissection. ECV calculations were done using attenuation of interventricular septum and blood pool non-contrast and arterial phase measurement adjusted by hematocrit. Myocardial relative enhancement (MRE) was evaluated as the attenuation ratio of the myocardium to the blood pool. Early myocardial ECV and MRE values of the aortic dissection and control groups were compared using an independent t-test and Mann–Whitney U test, respectively. The correlation between early ECV and MRE was assessed with Spearman's correlation. A binary logistic regression analysis was performed to assess the association between clinical and imaging variables with mortality. Results Fifty patients with aortic dissection and 50 controls were included; 36/50 in each group were male (72%), with a mean age of 58.34 ± 11.8 and 60.46 ± 16.8 years, respectively. In the aortic dissection group, early myocardial ECV values were higher in patients with Stanford type A dissection (17.47 ± 7.9% vs. 11.73 ± 5.1%, p = 0.004), while MRE values were lower(32.12 ± 7.8 vs. 40.4 ± 12.5, p = 0.007). Early ECV and MRE showed a strong positive correlation ( p < 0.001). Logistic regression identified ECV as a significant predictor of death ( p = 0.048). Conclusions Early myocardial ECV derived from routine arterial phase CTA imaging offers valuable and easily accessible prognostic insights into the survival of aortic dissection patients.