Evaluation of extracellular volume by computed tomography is useful for prediction of prognosis in dilated cardiomyopathy

Cardiac computed tomography (CT) is useful for the screening of coronary artery stenosis, and extracellular volume fraction (ECV) analysis by CT using new dedicated software is now available. Here, we evaluated the utility of ECV analysis using cardiac CT to predict patient prognosis in cases with dilated cardiomyopathy (DCM). We analyzed 70 cases with DCM and cardiac computed tomography (CT) with available late-phase images. We evaluated the ECV of the left ventricular myocardium (LVM) using commercially available software (Ziostation 2, Ziosoft Inc, Japan). ECV on LVM was 33.96 +/- 5.04%. Major adverse cardiac events (MACE) occurred in 21 cases ( 30%). ECV of the LVM on CT, endo- systolic volume, and rate of significant valvular disease were significantly higher in cases with MACE than in those without (37.16 +/- 5.91% vs. 32.59 +/- 3.95%, 194 +/- 109 vs. 138 +/- 78 ml and 57% vs. 20%, all P values < 0.05). LVEF was significantly lower in cases with MACE than in those without (23 +/- 8 vs. 31 +/- 11%, P = 0.0024). The best cut-off value of ECV on LVM for prediction of MACE was 32.26% based on receiver operating characteristics analysis. Cases with ECV = 32.26% had significantly higher MACE based on Kaplan-Meier analysis (P = 0.0032). Only ECV on LVM was an independent predictor of MACE based on a multivariate Cox proportional hazards model (P = 0.0354). Evaluation of ECV on LVM by CT is useful for predicting MACE in patients with DCM.