{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:56:58Z","timestamp":1781186218128,"version":"3.54.1"},"reference-count":35,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000646","name":"JSPS KAKENHI","doi-asserted-by":"publisher","award":["25K15929"],"award-info":[{"award-number":["25K15929"]}],"id":[{"id":"10.13039\/501100000646","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000646","name":"JSPS KAKENHI","doi-asserted-by":"publisher","award":["23K11891"],"award-info":[{"award-number":["23K11891"]}],"id":[{"id":"10.13039\/501100000646","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Left ventricular (LV) extracellular volume fraction (ECV) quantified by cardiac computed tomography (CT) reflects diffuse myocardial fibrosis. In patients with atrial fibrillation (AF) and reduced LV ejection fraction (LVEF), distinguishing tachycardia-induced cardiomyopathy from underlying myocardial disease remains challenging. The prognostic value of ECV for predicting reverse remodeling (RR) after catheter ablation for AF remains uncertain. We retrospectively analyzed 102 patients with LVEF \u2264 50% on echocardiography who underwent cardiac CT before AF ablation between May 2015 and April 2025. RR was defined as a \u226515% reduction in LV end-systolic volume with recovery of LVEF &gt; 50%, or an absolute increase in LVEF of \u226515%. RR occurred in 49 patients (48%). ECV was significantly lower in patients with RR than in those without (31.2 \u00b1 3.5% vs. 37.6 \u00b1 7.8%, p &lt; 0.001). Receiver operating characteristic analysis identified an optimal cutoff of 34.8% (area under the curve 0.77; sensitivity 88%; specificity 62%, p &lt; 0.001). In multivariable logistic regression analysis, lower ECV remained independently associated with RR (odds ratio 0.84; 95% confidence interval 0.75\u20130.95; p = 0.006). CT-derived ECV was associated with RR after AF ablation in patients with reduced LVEF and may provide additional information for clinical decision-making.<\/jats:p>","DOI":"10.3390\/jcdd13060264","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T12:14:58Z","timestamp":1781180098000},"page":"264","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Computed Tomography-Derived Left Ventricular Extracellular Volume Predicts Reverse Remodeling After Catheter Ablation for Atrial Fibrillation"],"prefix":"10.3390","volume":"13","author":[{"given":"Makiko","family":"Kinoshita","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8745-2162","authenticated-orcid":false,"given":"Hiroyuki","family":"Takaoka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusei","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitada","family":"Noguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Aoki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satomi","family":"Yashima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1692-4107","authenticated-orcid":false,"given":"Kazuki","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"},{"name":"Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Suzuki-Eguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonori","family":"Kanaeda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Chiba 283-8686, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshio","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter ablation for atrial fibrillation with heart failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1148\/rg.291085052","article-title":"A pattern-based approach to the assessment of delayed enhancement in nonischemic cardiomyopathy at CMR imaging","volume":"29","author":"Cummings","year":"2009","journal-title":"Radiographics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jcmg.2017.04.006","article-title":"Native T1 mapping and extracellular volume mapping for the assessment of diffuse myocardial fibrosis in dilated cardiomyopathy","volume":"11","author":"Nakamori","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1016\/j.jacc.2010.07.005","article-title":"ACCF\/SCCT\/ACR\/AHA\/ASE\/ASNC\/NASCI\/SCAI\/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American college of cardiology foundation appropriate use criteria task force, the society of cardiovascular computed tomography, the American college of radiology, the American heart association, the American society of echocardiography, the American society of nuclear cardiology, the North American society for cardiovascular imaging, the society for cardiovascular angiography and interventions, and the society for cardiovascular magnetic resonance","volume":"56","author":"Taylor","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.ijcard.2012.02.017","article-title":"Diagnostic accuracy of 320-slice computed-tomography for detection of significant coronary artery stenosis in patients with various heart rates and heart rhythms compared with conventional coronary-angiography","volume":"167","author":"Uehara","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.2169\/internalmedicine.4561-20","article-title":"Improved diagnostic performance of new-generation 320-slice computed tomography with forward-projected model-based iterative reconstruction solution for the assessment of late enhancement in left ventricular myocardium","volume":"59","author":"Takaoka","year":"2020","journal-title":"Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1148\/radiol.12112458","article-title":"Interstitial myocardial fibrosis assessed as extracellular volume fraction with low-radiation dose cardiac CT","volume":"264","author":"Nacif","year":"2012","journal-title":"Radiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1016\/j.jacep.2020.06.007","article-title":"Assessment of Diffuse Ventricular Fibrosis in Atrial Fibrillation Using Cardiac CT-Derived Myocardial Extracellular Volume Fraction","volume":"6","author":"Kidoh","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s00380-022-02220-x","article-title":"A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation","volume":"38","author":"Nishikawa","year":"2023","journal-title":"Heart Vessel."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/j.jacc.2010.11.030","article-title":"Prevalence and prognostic significance of left ventricular reverse remodeling in dilated cardiomyopathy receiving tailored medical treatment","volume":"57","author":"Merlo","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.jjcc.2020.11.007","article-title":"Clinical significance of left ventricular reverse remodeling after catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction","volume":"77","author":"Okada","year":"2021","journal-title":"J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.1016\/j.ijcard.2013.03.066","article-title":"Diagnostic accuracy of coronary 320 slice CT angiography using retrospective electrocardiogram gated acquisition compared with virtual prospective electrocardiogram gated acquisition with and without padding","volume":"168","author":"Takaoka","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s00380-022-02154-4","article-title":"Evaluation of extracellular volume by computed tomography is useful for prediction of prognosis in dilated cardiomyopathy","volume":"38","author":"Yashima","year":"2023","journal-title":"Heart Vessel."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s10554-018-1513-z","article-title":"Comparison of the different imaging time points in delayed phase cardiac CT for myocardial scar assessment and extracellular volume fraction estimation in patients with old myocardial infarction","volume":"35","author":"Hamdy","year":"2019","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.joa.2015.06.004","article-title":"Evaluation of periesophageal nerve injury after pulmonary vein isolation using the (13)C-acetate breath test","volume":"31","author":"Kanaeda","year":"2015","journal-title":"J. Arrhythm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00380-019-01475-1","article-title":"Association between left atrial reverse remodeling and maintenance of sinus rhythm after catheter ablation of persistent atrial fibrillation","volume":"35","author":"Kagawa","year":"2020","journal-title":"Heart Vessel."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1161\/CIRCEP.113.000586","article-title":"Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: Insights from the multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial","volume":"7","author":"Andrade","year":"2014","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_19","first-page":"411","article-title":"What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models","volume":"66","author":"Babyak","year":"2004","journal-title":"Psychosom. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.athoracsur.2019.01.088","article-title":"Surgical Ablation of Atrial Fibrillation in Patients with Tachycardia-Induced Cardiomyopathy","volume":"108","author":"Adademir","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1016\/j.jacc.2009.02.014","article-title":"Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: Long-term outcome after catheter ablation","volume":"53","author":"Medi","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1016\/j.jacc.2015.08.038","article-title":"Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management","volume":"66","author":"Gopinathannair","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1007\/s10554-021-02219-x","article-title":"Extracellular volume fraction by T1 mapping predicts improvement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic dilated cardiomyopathy and atrial fibrillation","volume":"37","author":"Azuma","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"10941","DOI":"10.1038\/s41598-021-90117-6","article-title":"Comprehensive assessment of left atrial and ventricular remodeling in paroxysmal atrial fibrillation by the cardiovascular magnetic resonance myocardial extracellular volume fraction and feature tracking strain","volume":"11","author":"Yamada","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1093\/ehjci\/jeu183","article-title":"T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: Quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy","volume":"16","author":"Buss","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1016\/j.jcmg.2020.05.029","article-title":"Identifying cardiac amyloid in aortic stenosis: ECV quantification by CT in TAVR patients","volume":"13","author":"Scully","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1253\/circj.CJ-20-0110","article-title":"JCS 2020 guideline on diagnosis and treatment of cardiac amyloidosis","volume":"84","author":"Kitaoka","year":"2020","journal-title":"Circ. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1093\/eurheartj\/ehad396","article-title":"Histological validation of atrial structural remodeling in patients with atrial fibrillation","volume":"44","author":"Takahashi","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1118\/1.598948","article-title":"Calculation of effective dose","volume":"27","author":"McCollough","year":"2000","journal-title":"Med. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1148\/rg.313105079","article-title":"Optimal tube potential for radiation dose reduction in pediatric CT: Principles, clinical implementations, and pitfalls","volume":"31","author":"Yu","year":"2011","journal-title":"Radiographics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in patients with heart failure and reduced ejection fraction","volume":"381","author":"McMurray","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart failure","volume":"383","author":"Packer","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1056\/NEJMc2112411","article-title":"Empagliflozin and major renal outcomes in heart failure","volume":"385","author":"Packer","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jcmg.2022.08.005","article-title":"Comprehensive Evaluation of Left Ventricle Dysfunction by a New Computed Tomography Scanner: The E-PLURIBUS Study","volume":"16","author":"Andreini","year":"2023","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1016\/j.hroo.2025.09.025","article-title":"The usefulness of catheter ablation even in patients with myocardial impairment: Myocardial extracellular volume assessed by preablation planning computed tomography cannot predict atrial fibrillation recurrence","volume":"6","author":"Tsuruta","year":"2025","journal-title":"Heart Rhythm O2"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/264\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:00:44Z","timestamp":1781182844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcdd13060264"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13060264","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}