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<p><i>Purpose</i>: Patients with severe aortic stenosis (AS) present a high but heterogeneous risk of adverse outcomes. Although risk stratification relies primarily on clinical scores, myocardial fibrosis assessed by computed tomography–derived extracellular volume (ECV-CT) has emerged as a potential prognostic marker. This study aimed to determine whether ECV-CT provides independent and incremental prognostic value beyond established clinical risk scores in patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) planning. <i>Methods</i>: In this single-centre prospective study, consecutive patients with severe AS referred for TAVR planning computed tomography were included. ECV-CT was quantified from pre- and post-contrast images by calculating the ratio of attenuation change in the interventricular septum to that in the left ventricular blood pool. Prognostic performance was compared with EuroSCORE II and PRIORiTize-TAVI. The primary endpoint was a composite of all-cause mortality or cardiovascular hospitalization. <i>Results</i>: A total of 316 patients (mean age 81 ± 8 years; 44% male) were analysed. Median ECV-CT was 33.9% (IQR 29.5–38.7). Over a median follow-up of 340 days (IQR 198–517), 72 patients experienced the composite endpoint (47 deaths, 25 cardiovascular hospitalizations). Higher ECV-CT values were associated with adverse outcomes. In multivariable Cox regression, log-transformed ECV-CT remained independently predictive after adjustment for clinical scores. Model discrimination significantly improved with the addition of logECV-CT. <i>Conclusion</i>: ECV-CT–derived myocardial fibrosis assessment provides independent and incremental prognostic information beyond established clinical risk scores in severe AS, potentially enhancing risk stratification before TAVR.</p>

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Computed tomography-derived myocardial extracellular volume provides incremental prognostic value over clinical risk scores in patients with severe aortic stenosis

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Rita Almeida Carvalho,
  • Márcia Presume,
  • Rita Reis Santos,
  • Pedro M. Lopes,
  • Francisco Albuquerque,
  • Francisco Gama,
  • Pedro Freitas,
  • Cláudia Silva,
  • Sara Guerreiro,
  • João Abecasis,
  • Ana Coutinho Santos,
  • Carla Saraiva,
  • Rui Campante Teles,
  • Manuel Sousa Almeida,
  • Pedro Adragão,
  • António M. Ferreira

摘要

Purpose: Patients with severe aortic stenosis (AS) present a high but heterogeneous risk of adverse outcomes. Although risk stratification relies primarily on clinical scores, myocardial fibrosis assessed by computed tomography–derived extracellular volume (ECV-CT) has emerged as a potential prognostic marker. This study aimed to determine whether ECV-CT provides independent and incremental prognostic value beyond established clinical risk scores in patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) planning. Methods: In this single-centre prospective study, consecutive patients with severe AS referred for TAVR planning computed tomography were included. ECV-CT was quantified from pre- and post-contrast images by calculating the ratio of attenuation change in the interventricular septum to that in the left ventricular blood pool. Prognostic performance was compared with EuroSCORE II and PRIORiTize-TAVI. The primary endpoint was a composite of all-cause mortality or cardiovascular hospitalization. Results: A total of 316 patients (mean age 81 ± 8 years; 44% male) were analysed. Median ECV-CT was 33.9% (IQR 29.5–38.7). Over a median follow-up of 340 days (IQR 198–517), 72 patients experienced the composite endpoint (47 deaths, 25 cardiovascular hospitalizations). Higher ECV-CT values were associated with adverse outcomes. In multivariable Cox regression, log-transformed ECV-CT remained independently predictive after adjustment for clinical scores. Model discrimination significantly improved with the addition of logECV-CT. Conclusion: ECV-CT–derived myocardial fibrosis assessment provides independent and incremental prognostic information beyond established clinical risk scores in severe AS, potentially enhancing risk stratification before TAVR.