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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
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Multimodality Characterization of Apical Sparing in Severe Aortic Stenosis Using CT-Derived ECV
Session:
Sessão de Comunicações Orais 12 – Doença Valvular Cardíaca: diagnóstico, estratificação de risco e abordagem terapêutica
Speaker:
André Filipe Silva Pereira Martins Lobo
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Andre Lobo; Marta Catarina Almeida; Carolina Castro; José Cavadas; Rafael Teixeira; Inês Rodrigues; António Gonçalves; Mariana Brandão; Nuno Dias Ferreira; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Calibri",sans-serif">Background: </span><span style="font-family:"Calibri",sans-serif">In aortic stenosis (AS), myocardial extracellular volume (ECV) can be non-invasively quantified by computed tomography (CT). It is associated with adverse myocardial remodeling and worse prognosis. However, its regional myocardial distribution remains poorly characterized. Echocardiographic strain imaging has demonstrated a pattern of relative apical sparing in patients with AS, raising the hypothesis of a corresponding basal-to-apical gradient in ECV. Whether such a gradient exists on CT-derived ECV and how it relates to echocardiographic global longitudinal strain (GLS) remains unknown.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Calibri",sans-serif">Methods: Retrospective analysis of patients with severe AS undergoing cardiac CT for transcatheter aortic valve implantation (TAVI) planning (April 2024-April 2025). Standardized delayed-phase dual-energy acquisition enabling opportunistic myocardial ECV quantification was performed in all cases. ECV was measured in basal, mid-ventricular, and apical short-axis slices. In the subgroup of patients with available GLS data by echocardiography, GLS and relative apical sparing were analyzed in relation to CT-derived ECV metrics.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Calibri",sans-serif">Results: A total of 253 patients with available CT-derived ECV data were included. A basal-to-apical gradient was observed, with the highest median ECV at the basal level (31.4%, IQR 6.25), decreasing at the mid-ventricular level (29.5%, IQR 6.50), and reaching the lowest values at the apex (27.6%, IQR 6.50; all pairwise p<0.001). The median basal-to-apical ECV ratio was 1.13 (IQR 0.27) and was positively associated with global ECV burden (p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Calibri",sans-serif">Among patients with available echo strain GLS (n = 162), global CT-derived ECV was inversely correlated with GLS (r = −0.21, p = 0.008), indicating worse myocardial deformation with increasing CT-ECV. The basal-to-apical CT-ECV ratio correlated with the echo strain–derived apical-to-basal ratio (r = 0.17, p = 0.048). In addition, patients with apical sparing on echo strain imaging had a significantly higher basal-to-apical CT-ECV gradient (p = 0.024).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Calibri",sans-serif">Conclusion: CT-derived ECV demonstrates a consistent basal-to-apical gradient in severe aortic stenosis, with basal predominance and relative apical sparing. This structural pattern resembles the one assessed by GLS in echocardiography, highlighting the importance of a multimodality approach for evaluating myocardial damage in the setting of severe AS. These findings suggest that an apical sparing pattern may also be characterized by CT, warranting further validation.</span></span></span></p>
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