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Meta-Analysis
. 2025 Mar 3;26(3):518-531.
doi: 10.1093/ehjci/jeae324.

Prognostic value of myocardial computed tomography-derived extracellular volume in severe aortic stenosis requiring aortic valve replacement: a systematic review and meta-analysis

Andrea Faggiano  1   2 , Elisa Gherbesi  1 , Stefano Carugo  1   2 , Matteo Brusamolino  2   3 , Dan Alexandru Cozac  4   5 , Elena Cozza  4 , Maria Teresa Savo  4 , Francesco Cannata  3 , Marco Guglielmo  6   7 , Lucia La Mura  8 , Fabio Fazzari  3 , Nazario Carrabba  9 , Edoardo Conte  10 , Saima Mushtaq  3 , Andrea Baggiano  3 , Andrea Igoren Guaricci  11 , Roberto Pedrinelli  12 , Ciro Indolfi  13 , Gianfranco Sinagra  14   15 , Pasquale Perrone Filardi  8 , Valeria Pergola  4 , Gianluca Pontone  3   16
Affiliations
Meta-Analysis

Prognostic value of myocardial computed tomography-derived extracellular volume in severe aortic stenosis requiring aortic valve replacement: a systematic review and meta-analysis

Andrea Faggiano et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Computed tomography (CT)-derived extracellular volume (ECV) fraction is a non-invasive method to quantify myocardial fibrosis. Evaluating CT-ECV during aortic valve replacement (AVR) planning CT in severe aortic stenosis (AS) may aid prognostic stratification. This meta-analysis evaluated the prognostic significance of CT-ECV in severe AS necessitating AVR. Electronic database searches of PubMed, Ovid MEDLINE, and Cochrane Library were performed. The primary outcome was to compare the occurrence of a composite of cardiovascular outcomes in patients with severe AS undergoing AVR with elevated myocardial CT-ECV values vs. patients with normal values. Secondary outcomes included all-cause mortality and heart failure (HF)-related hospitalization. A total of 1223 patients undergoing AVR for severe AS were included in 10 studies: 524 patients with high values of CT-ECV and 699 with normal values of CT-ECV. The pooled CT-ECV cut-off to define elevated values and predict prognosis was 30.7% [95% confidence interval (CI): 28.5-33.7%]. At a mean follow-up of 17.9 ± 2.3 months after AVR, patients with elevated CT-ECV experienced a significantly higher number of cardiovascular events [43.4 vs. 14.0%; odds ratio (OR): 4.3, 95% CI: 3.192-5.764, P < 0.001]. Regarding secondary outcomes, all-cause mortality occurred in 29.3% of patients with elevated CT-ECV vs. 11.6% with CT-ECV below the cut-off (OR: 3.5, 95% CI: 2.276-5.311, P < 0.001), whereas HF hospitalization was observed in 25.5% vs. 5.9% (OR: 4.9, 95% CI: 2.283-10.376, P < 0.001). Patients undergoing AVR for severe AS with elevated CT-ECV values experience a worse post-intervention prognosis. The implementation of CT-ECV evaluation in routine AVR planning protocols should be considered.

Keywords: aortic stenosis; aortic valve replacement; cardiac computed tomography angiography; computed tomography–derived extracellular volume fraction.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
PRISMA flow chart showing the search strategy and manuscripts selection process.
Figure 2
Figure 2
Forest plot for OR of the primary outcome (composite cardiovascular outcome) in patients with high vs. normal CT-ECV. Relative weight of each study is reported on the right side. CI, confidence interval; CV, cardiovascular, CT-ECV, computed tomography extracellular volume.
Figure 3
Figure 3
Forest plot for OR of all-cause mortality in patients with high vs. normal CT-ECV. Relative weight of each study is reported on the right side. CI, confidence interval; CT-ECV, computed tomography extracellular volume.
Figure 4
Figure 4
Forest plot for OR of HF hospitalizations in patients with high vs. normal CT-ECV. Relative weight of each study is reported on the right side. CI, confidence interval; HF, heart failure, CT-ECV, computed tomography extracellular volume.
Figure 5
Figure 5
Meta-regression analysis between LVEF and the effect size of cardiovascular (CV) outcomes. OR, odds rartio.
See this image and copyright information in PMC

References

    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2022;43:561–32. - PubMed
    1. Luengo-Fernandez R, Walli-Attaei M, Gray A, Torbica A, Maggioni AP, Huculeci R et al. Economic burden of cardiovascular diseases in the European Union: a population-based cost study. Eur Heart J 2023;44:4752–67. - PMC - PubMed
    1. Birger M, Kaldjian AS, Roth GA, Moran AE, Dieleman JL, Bellows BK. Spending on cardiovascular disease and cardiovascular risk factors in the United States: 1996 to 2016. Circulation 2021;144:271–82. - PMC - PubMed
    1. Kadkhodayan A, Lin G, Popma JJ, Reardon MJ, Little SH, Adams DH et al. A paradox between LV mass regression and hemodynamic improvement after surgical and transcatheter aortic valve replacement. Struct Hear 2017;1:51–61.
    1. Ueyama HA, Chopra L, Dalsania A, Prandi FR, Sharma SK, Kini A et al. Transcatheter aortic valve replacement outcomes in patients with low-flow very low-gradient aortic stenosis. Eur Heart J Cardiovasc Imaging 2024;25:267–77. - PubMed