Quantification of extracellular volume with cardiac computed tomography in patients with dilated cardiomyopathy

BackgroundCardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECV_CCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECV_CMR as the reference technique.Methods39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECV_CMR and ECV_CCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed.ResultsMean age of enrolled patients was 62 ?± ?11 years, and mean LVEF at CMR was 35.4 ?± ?10.7%. Overall radiation exposure for ECV estimation was 2.1 ?± ?1.1 ?mSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECV_CCT demonstrated slightly lower values compared to ECV_CMR (all segments, 31.8 ?± ?6.5% vs 33.9 ?± ?8.0%, p ?< ?0.001). At regression analysis, strong correlations were described (all segments, r ?= ?0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECV_CMR and ECV_CCT for global analysis was 2.1 (95% CI: ?6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECV_CCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively).ConclusionsECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.