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Impact of CT-Derived Extracellular Volume on LV Remodeling After TAVR
Session:
Sessão de Comunicações Orais 16 – Imagiologia avançada para estratificação de risco: do ECV à RMC em contexto de vida real
Speaker:
Rita Barbosa Sousa
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Barbosa Sousa; Rita Almeida Carvalho; Rita Santos; Samuel Azevedo; Débora da Silva Correia; Pedro Lopes; Sara Guerreiro; Cláudia Silva; Francisco Gama; Pedro Freitas; João Abecasis; António Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">INTRODUCTION:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> Left ventricular (LV) reverse remodeling (RR) can occur after transcatheter aortic valve replacement (TAVR), but it is largely influenced by the underlying myocardial changes and remains incompletely understood. Pre-TAVR CT-derived extracellular volume (ECV-CT)</span></span>, <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">a marker of extracellular matrix expansion (including both focal replacement fibrosis and diffuse interstitial fibrosis), has been correlated with worse outcomes, but its association with LV RR is ill defined. We aimed to assess the association between pre-TAVR ECV-CT and LV RR at 1-year post-TAVR.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">METHODS:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Single-center retrospective study including consecutive patients with severe symptomatic AS undergoing TAVR between 2022-2024. Only patients with echocardiographic (TTE) data both before and 1-year after TAVR were included. All patients underwent a pre-TAVR-planning CT on a 192-slice dual-source scanner, using an additional post-contrast low-radiation-dose prospective acquisition. ECV-CT was calculated according to the equation and example in Fig1. Patients were grouped by mean ECV-CT, and TTE measures were compared before and after TAVR within each group using paired analyses.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">RESULTS</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: A total of 81 patients were included (median age 82 (IQR 78-87) years; 47% male). Pre-TAVR TTE showed a median transaortic gradient of 47mmHg (IQR 41–56), a mean aortic valve area of 0.75±0.19 cm², a median indexed LV mass (LVMi) of 138 g/m² (IQR 106–161) and a median indexed LV end-diastolic volume (LVEDVi) of 51mL/m² (IQR 41–68). The median LV ejection fraction (LVEF) was 56% (IQR 51–63) and mean global longitudinal strain (GLS) was -15 ± 4%. No patient had a clinical diagnosis of cardiac amyloidosis. The mean ECV-CT was 33.9 ± 8.0%. Patients with ECV-CT </span></span><span style="font-size:11.0pt"><span style="font-family:Symbol"><span style="color:black">³</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">33.9% had numerically higher LVMi (<span style="color:black">143 g/m² [IQR 107–161] vs 130 g/m² [IQR 106–161], p=0.481). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">At 1-year post-TAVR, TTE demonstrated a significant reduction in LVMi</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> to 121 g/m² (IQR 98–148; p=0.018). </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">No significant changes were observed in other parameters [LVEDVi 51 mL/m² (IQR 38–66), LVEF 56% (IQR 52–61) and (GLS -16 ± 4%); p>0.05 for all].</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">After stratification according to mean ECV-CT, patients with ECV-CT <33.9% (n=42) showed a non-statistically significant regression in LVMi (130 g/m² [IQR 106–161] vs 121 g/m² [IQR 101–149]; p=0.333), whereas those with ECV-CT </span></span></span><span style="font-size:11.0pt"><span style="font-family:Symbol"><span style="color:black">³</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">33.9% (n=33) demonstrated a significant reduction in LVMi (143 g/m² [IQR 107–161] vs 122 g/m² [IQR 91–142]; p=0.023). Both groups achieved similar LVMi at 1-year after TAVR (p=0.717) (<strong>Figure 1</strong>).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">CONCLUSION: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In this preliminary study, patients with elevated ECV-CT showed a post-TAVR reduction in LVMi that brought them to levels similar to those with normal ECV. This pattern suggests that elevated ECV-CT, despite associated with poorer prognosis in previous studies, is not necessarily a marker of irreversible adverse remodeling in aortic stenosis</span></span></span></span></p> <p style="text-align:justify"> </p>
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