Identifying Cardiac Amyloid in Aortic Stenosis: ECV Quantification by CT in TAVR Patients |
| |
| Affiliation: | 1. Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom;2. Institute of Cardiovascular Sciences, University College London, London, United Kingdom;3. Siemens Healthineers, Forchheim, Germany;4. William Harvey Research Institute, Queen Mary University of London, London, United Kingdom;5. John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom;6. Nuclear Medicine, Swansea Bay UHB, Port Talbot, United Kingdom;7. Minneapolis Heart Institute, Minneapolis, Minnesota;8. Institute of Nuclear Medicine, University College London, London, United Kingdom;9. NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom;10. National Amyloidosis Centre, University College London, London, United Kingdom;11. NIHR Barts Biomedical Research Centre, London, United Kingdom |
| |
| Abstract: | ObjectivesThe purpose of this study was to validate computed tomography measured ECV (ECVCT) as part of routine evaluation for the detection of cardiac amyloid in patients with aortic stenosis (AS)-amyloid.BackgroundAS-amyloid affects 1 in 7 elderly patients referred for transcatheter aortic valve replacement (TAVR). Bone scintigraphy with exclusion of a plasma cell dyscrasia can diagnose transthyretin-related cardiac amyloid noninvasively, for which novel treatments are emerging. Amyloid interstitial expansion increases the myocardial extracellular volume (ECV).MethodsPatients with severe AS underwent bone scintigraphy (Perugini grade 0, negative; Perugini grades 1 to 3, increasingly positive) and routine TAVR evaluation CT imaging with ECVCT using 3- and 5-min post-contrast acquisitions. Twenty non-AS control patients also had ECVCT performed using the 5-min post-contrast acquisition.ResultsA total of 109 patients (43% male; mean age 86 ± 5 years) with severe AS and 20 control subjects were recruited. Sixteen (15%) had AS-amyloid on bone scintigraphy (grade 1, n = 5; grade 2, n = 11). ECVCT was 32 ± 3%, 34 ± 4%, and 43 ± 6% in Perugini grades 0, 1, and 2, respectively (p < 0.001 for trend) with control subjects lower than lone AS (28 ± 2%; p < 0.001). ECVCT accuracy for AS-amyloid detection versus lone AS was 0.87 (0.95 for 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid Perugini grade 2 only), outperforming conventional electrocardiogram and echocardiography parameters. One composite parameter, the voltage/mass ratio, had utility (similar AUC of 0.87 for any cardiac amyloid detection), although in one-third of patients, this could not be calculated due to bundle branch block or ventricular paced rhythm.ConclusionsECVCT during routine CT TAVR evaluation can reliably detect AS-amyloid, and the measured ECVCT tracks the degree of infiltration. Another measure of interstitial expansion, the voltage/mass ratio, also performed well. |
| |
| Keywords: | aortic stenosis cardiac amyloidosis computed tomography extracellular volume AS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" aortic stenosis AS-amyloid" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" dual aortic stenosis and cardiac amyloid pathology ATTR-CA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" transthyretin-related cardiac amyloidosis AUC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" area under the curve CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" computed tomography CTCA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" computed tomography coronary angiogram DPD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" sup" ," $" :{" loc" :" post" }," _" :" 99m" },{" #name" :" __text__" ," _" :" Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ECG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" electrocardiogram ECV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" extracellular volume extracellular volume quantification by computed tomography imaging hs-TnT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" high-sensitivity troponin T IVSd" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" interventricular septal diameter MCF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0155" }," $$" :[{" #name" :" text" ," _" :" myocardial contraction fraction PWd" },{" #name" :" keyword" ," $" :{" id" :" kwrd0165" }," $$" :[{" #name" :" text" ," _" :" posterior wall diameter RBBB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0175" }," $$" :[{" #name" :" text" ," _" :" right bundle branch block SPECT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0185" }," $$" :[{" #name" :" text" ," _" :" single-photon emission computed tomography TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0195" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
