Abstract
Extent of myocardial fibrosis in hemodialysis patients has been associated with poor prognosis. Myocardial extracellular volume (ECV) quantification using contrast enhanced cardiac computed tomography (CT) is a novel method to determine extent of myocardial fibrosis. Cardiac CT-based myocardial ECV in hemodialysis patients with those of propensity-matched non-hemodialysis control subjects were compared. Twenty hemodialysis patients (mean age, 67.4 ± 9.6 years; 80% male) and 20 propensity-matched non-hemodialysis controls (mean age, 66.3 ± 9.1 years; 85% male) who underwent comprehensive cardiac CT consisted of calcium scoring, coronary CT angiography, stress perfusion CT and delayed enhancement CT were evaluated. Myocardial ECV was significantly greater in the hemodialysis group than in the control group (33.8 ± 4.7% versus 26.6 ± 2.9%; P < 0.0001). In the hemodialysis group, modest correlation was evident between myocardial ECV and left atrial volume index (r = 0.54; P = 0.01), while there was no correlation between myocardial ECV and other cardiac parameters including left ventricular mass index and severity of myocardial ischemia. Cardiac CT-based myocardial ECV may offer a potential imaging biomarker for myocardial fibrosis in HD patients.
Highlights
Extent of myocardial fibrosis in hemodialysis patients has been associated with poor prognosis
In HD patients, we examined the relationship between myocardial extracellular volume (ECV) and various parameters including left ventricular (LV) mass index (LVMI), left atrial volume index (LAVI), and severity of myocardial ischemia
A comprehensive cardiac computed tomography (CT) consisted of coronary CT angiography (CTA), stress dynamic CT perfusion (CTP) and ECV measurement is considered for patients between 45 and 85 years old who are clinically referred for coronary CT angiography with moderate to high pretest likelihood for obstructive coronary artery disease
Summary
Extent of myocardial fibrosis in hemodialysis patients has been associated with poor prognosis. Myocardial extracellular volume (ECV) quantification using contrast enhanced cardiac computed tomography (CT) is a novel method to determine extent of myocardial fibrosis. Cardiac magnetic resonance (CMR) can determine the extracellular volume fraction (ECV) of left ventricular (LV) myocardium by measuring T1 relaxation times before and after administration of gadolinium contrast, and has become a noninvasive standard reference of myocardial fibrosis[8,9,10,11] Myocardial ECV is increased by myocardial fibrosis in a wide range of cardiac diseases, including cardiac sarcoidosis, cardiac amyloidosis, ischemic cardiomyopathy, hypertrophy cardiomyopathy and dilated cardiomyopathy[11]. Several studies have demonstrated the potential of contrast enhanced cardiac computed tomography (CT) to assess myocardial fibrosis with myocardial ECV. Whether or not ECV quantification by cardiac CT allows assessment of increased myocardial fibrosis in HD patients has not been investigated
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