Fig 1.
Representative example of extracellular volume (ECV) fraction measurement.
Myocardial and blood pool attenuation values were measured at the mid segment of the septum and at the descending aorta; respectively, in the pre-contrast (A) and 7 minutes post-contrast (C) CT scan. The contrast scan (B) was used to localize the region of interest, which than could be replicated to the pre- and post-contrast scan. Attenuation values were than used to calculate ECV fraction.
Table 1.
Baseline characteristics.
Fig 2.
ECV fraction of patients with severe aortic stenosis and normal subjects.
Extracellular volume (ECV) fraction was significantly higher in patients with severe aortic stenosis than in normal subjects.
Fig 3.
ECV fraction distribution in patients with symptomatic severe AS.
Mean Extracellular volume (ECV) fraction was 40% in patients with severe aortic stenosis, and 50% of patients (Q1-Q3) had an ECV fraction between 30.5% and 47.8%.
Fig 4.
The relation between ECV fraction and functional/imaging parameters.
Extracellular volume (ECV) fraction correlated positively with New York Heart Association (NYHA) functional class (A) and left atrial volume index (LAVI) (B), and negatively with left ventricular ejection fraction (LVEF) (C).
Fig 5.
The relation between ECV fraction and staging classification of AS, based on the extent of cardiac damage.
(A) In a Pearson correlation model, extracellular volume (ECV) fraction correlated significantly and progressively with aortic stenosis (AS) stage. To note, eight patients were at stage 0, nine patients at stage 1, 41 patients at stage 2, eight patients at stage 3, and none at stage 4. (B) In a logistic regression model, patients in stages 2 or 3 had a significantly higher ECV fraction compared to patients at stages 0 or 1.
Fig 6.
The relation between ECV fraction and clinical outcomes.
(A) In a logistic regression model, extracellular volume (ECV) fraction in patients hospitalized for heart failure (HF) at 12-months was significantly higher than in those who were not. (B) Increased ECV fraction was associated with worse functional class at 12 months (r = 0.6, p<0.001). To note, there were no patients with NYHA FC 4 in our cohort. NYHA = New York Heart Association; FC = Functional class.
Fig 7.
Galectin-3 level in patients with severe AS.
(A) Galectin-3 level (ng/ml) was significantly higher in patients with severe aortic stenosis (AS) than in normal subjects. (B) Galectin-3 level was significantly higher in the highest decile of extracellular volume (ECV) fraction (ECV >57%) versus the lowest decile (ECV <26%).
Fig 8.
The ability of ECV fraction to predict clinical outcomes.
Receiver operating curve was used to examine the ability of extracellular volume (ECV) fraction to predict the combined clinical outcomes of stroke and hospitalization for heart failure at 12-months after aortic valve intervention. ECV fraction had a favorable curve with an area under the curve (AUC) of 0.77, 95% confidence interval (CI): 0.65–0.88.