Bernhard, Benedikt; Leib, Zoe; Dobner, Stephan; Demirel, Caglayan; Caobelli, Federico; Rominger, Axel; Schütze, Jonathan; Grogg, Hanna; Alwan, Louhai; Spano, Giancarlo; Boscolo Berto, Martina; Lanz, Jonas; Pilgrim, Thomas; Windecker, Stephan; Stortecky, Stefan; Gräni, Christoph (2023). Routine 4D Cardiac CT to Identify Concomitant Transthyretin Amyloid Cardiomyopathy in Older Adults with Severe Aortic Stenosis. Radiology, 309(3), e230425. Radiological Society of North America 10.1148/radiol.230425
Full text not available from this repository. (Request a copy)Background Transthyretin amyloid cardiomyopathy (ATTR-CM) often coexists with severe aortic stenosis (AS). Although strain analysis from cardiac MRI and echocardiography was demonstrated to predict coexisting ATTR-CM, comparable data from four-dimensional (4D) cardiac CT are lacking despite wide availability. Purpose To evaluate the diagnostic performance of 4D cardiac CT-derived parameters in identifying ATTR-CM in older adults considered for transcatheter aortic valve implantation (TAVI). Materials and Methods This prospective single-center screening study for ATTR-CM included consecutive patients with severe AS considered for TAVI who underwent 4D cardiac CT between August 2019 and August 2021 approximately 1 day before technetium 99m (99mTc) 3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) scintigraphy. The diagnostic performance of CT-based left ventricular (LV), right ventricular, and left atrial dimensions, ejection fraction (EF), and myocardial strain were evaluated against 99mTc-DPD scintigraphy as the reference standard to identify ATTR-CM. Predictors and an unweighted cardiac CT score were validated with internal bootstrapping. The assignment of variables to the score was based on cutoff values achieving the highest Youden index J. Results Among 263 participants (mean age, 83 years ± 4.6 [SD]; 149 male and 114 female participants), 99mTc-DPD scintigraphy (Perugini grade 2 or 3) confirmed coexisting ATTR-CM in 27 (10.3%). CT-derived LV mass index, LV and LA global longitudinal strain (GLS), and relative apical longitudinal strain each predicted the presence of ATTR-CM with an area under the curve (AUC) of at least 0.70. Implementing these parameters with cutoff values of 81 g/m2 or higher, -14.9% or higher, less than 11.5%, and 1.7 or higher in the CT score, respectively, yielded high diagnostic performance (AUC = 0.89; 95% CI: 0.81, 0.94; P < .001) robust to internal bootstrapping validation (AUC = 0.88; 95% CI: 0.82, 0.94). If two criteria were fulfilled, the sensitivity and specificity in the detection of ATTR-CM were 96.3% (95% CI: 81.0, 99.9) and 58.9% (95% CI: 52.3, 65.2), respectively. Conclusion When compared against 99mTc-DPD scintigraphy as the reference standard, routine 4D cardiac CT in older adults considered for TAVI provided high diagnostic performance in the detection of concomitant ATTR-CM by assessing LV and left atrial GLS, relative apical longitudinal strain, and LV mass index. ClinicalTrials.gov registration no.: NCT04061213 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tavakoli and Onder in this issue.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Bernhard, Benedikt, Dobner, Stephan, Demirel, Caglayan, Caobelli, Federico, Rominger, Axel Oliver, Schütze, Jonathan, Alwan, Louhai, Spano, Giancarlo, Boscolo Berto, Martina, Lanz, Jonas, Pilgrim, Thomas, Windecker, Stephan, Stortecky, Stefan, Gräni, Christoph |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1527-1315 |
Publisher: |
Radiological Society of North America |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
14 Dec 2023 14:13 |
Last Modified: |
14 Dec 2023 14:13 |
Publisher DOI: |
10.1148/radiol.230425 |
PubMed ID: |
38085082 |
URI: |
https://boris.unibe.ch/id/eprint/190240 |
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