{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:57:22Z","timestamp":1790175442504,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>\n              Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECV\n              <jats:sub>CT<\/jats:sub>\n              ), and has prognostic utility in several diseases. This study aims to map out regional differences in ECV\n              <jats:sub>CT<\/jats:sub>\n              to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>\n              Three prospective cohorts were included: patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts. Controls had CT angiography and cardiac magnetic resonance demonstrating no significant coronary artery disease or infarction. Global and regional ECV\n              <jats:sub>CT<\/jats:sub>\n              was analyzed, and its association with mortality was assessed for patients with AS.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              In 199 patients, controls (n=65; 66% male), AS (n=115), and coexisting AS and transthyretin cardiac amyloidosis (n=19) had a global ECV\n              <jats:sub>CT<\/jats:sub>\n              of 26.1 (25.0\u201327.8%) versus 29.1 (27.5\u201331.1%) versus 37.4 (32.5\u201346.6%), respectively;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001. Across cohorts, ECV\n              <jats:sub>CT<\/jats:sub>\n              was higher at the base (versus apex), the inferoseptum (versus anterolateral wall), and the subendocardium (versus subepicardium);\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05 for all. Among patients with AS, epicardial ECV\n              <jats:sub>CT<\/jats:sub>\n              , rather than any other regional value or global ECV\n              <jats:sub>CT<\/jats:sub>\n              , was the strongest predictor of mortality at a median of 3.9 (max 6.3) years (adjusted hazard ratio, 1.21 [95% CI, 1.08\u20131.36];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.002).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>\n              Regional differences in ECV\n              <jats:sub>CT<\/jats:sub>\n              suggest a predilection for fibrosis and amyloid infiltration at the base, subendocardium, inferior wall, and septum more than the anterior and lateral myocardium. ECV\n              <jats:sub>CT<\/jats:sub>\n              can predict long-term mortality with the subepicardium demonstrating the strongest discriminatory power.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifiers: NCT03029026 and NCT03094143.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.123.015996","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T18:06:31Z","timestamp":1716314791000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Regional Distribution of Extracellular Volume Quantified by Cardiac CT in Aortic Stenosis: Insights Into Disease Mechanisms and Impact on Outcomes"],"prefix":"10.1161","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct03029026","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03094143","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3433-8128","authenticated-orcid":true,"given":"Kush P.","family":"Patel","sequence":"first","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."},{"name":"Institute of Cardiovascular Sciences, University College London, United Kingdom (K.P.P., P.R.S., J.C.M., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Scully","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7149-5384","authenticated-orcid":true,"given":"Bunny","family":"Saberwal","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."},{"name":"William Harvey Research Institute, Queen Mary University of London, United Kingdom (B.S., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apurva","family":"Sinha","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna J.L.","family":"Yap-Sanderson","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Cheasty","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mullen","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon J.","family":"Menezes","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."},{"name":"Institute of Nuclear Medicine, University College London, United Kingdom (L.J.M.)."},{"name":"NIHR University College London Hospitals Biomedical Research Centre, United Kingdom (L.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8071-1491","authenticated-orcid":true,"given":"James C","family":"Moon","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7497-6266","authenticated-orcid":true,"given":"Francesca","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."},{"name":"William Harvey Research Institute, Queen Mary University of London, United Kingdom (B.S., F.P., T.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernst","family":"Klotz","sequence":"additional","affiliation":[{"name":"Siemens Healthineers, Forchheim, Germany (E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1560-7414","authenticated-orcid":true,"given":"Thomas A.","family":"Treibel","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.)."},{"name":"Institute of Cardiovascular Sciences, University College London, United Kingdom (K.P.P., P.R.S., J.C.M., T.A.T.)."},{"name":"William Harvey Research Institute, Queen Mary University of London, United Kingdom 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