Victorian Heart Institute, Monash University, Clayton, VIC, Australia; Victorian Heart Hospital, Monash Health, Clayton, VIC, Australia.
Victorian Heart Institute, Monash University, Clayton, VIC, Australia; Victorian Heart Hospital, Monash Health, Clayton, VIC, Australia; University of Adelaide, Adelaide, Australia.
J Cardiovasc Comput Tomogr. 2024 Sep-Oct;18(5):457-464. doi: 10.1016/j.jcct.2024.06.002. Epub 2024 Jun 14.
Cardiac computed tomography quantification of extracellular volume fraction (CT-ECV) is an emerging biomarker of myocardial fibrosis which has demonstrated high reproducibility, diagnostic and prognostic utility. However, there has been wide variation in the CT-ECV protocol in the literature and useful disease cut-offs are yet to be established. The objectives of this meta-analysis were to describe mean CT-ECV estimates and to estimate the effect of CT-ECV protocol parameters on between-study variation.
We conducted a meta-analysis of studies assessing CT-ECV in healthy and diseased participants. We used meta-analytic methods to pool estimates of CT-ECV and performed meta-regression to identify the contribution of protocol parameters to CT-ECV heterogeneity.
Thirteen studies had a total of 248 healthy participants who underwent CT-ECV assessment. Studies of healthy participants had high variation in CT-ECV protocol parameters. The pooled estimate of CT-ECV in healthy participants was 27.6% (95%CI 25.7%-29.4%) with significant heterogeneity (I = 93%) compared to 50.2% (95%CI 46.2%-54.2%) in amyloidosis, 31.2% (28.5%-33.8%) in severe aortic stenosis and 36.9% (31.6%-42.3%) in non-ischaemic dilated cardiomyopathies. Meta-regression revealed that CT protocol parameters account for approximately 25% of the heterogeneity in CT-ECV estimates.
CT-ECV estimates for healthy individuals vary widely in the literature and there is significant overlap with estimates in cardiac disease. One quarter of this heterogeneity is explained by differences in CT-ECV protocol parameters. Standardization of CT-ECV protocols is necessary for widespread implementation of CT-ECV assessment for diagnosis and prognosis.
心脏计算机断层扫描定量检测细胞外容积分数（CT-ECV）是一种新兴的心肌纤维化生物标志物，具有较高的重现性、诊断和预后价值。然而，文献中 CT-ECV 方案存在广泛差异，有用的疾病截断值尚未确定。本荟萃分析的目的是描述平均 CT-ECV 估计值，并估计 CT-ECV 方案参数对研究间变异的影响。
我们对评估健康和患病参与者 CT-ECV 的研究进行了荟萃分析。我们使用荟萃分析方法对 CT-ECV 估计值进行了汇总，并进行了荟萃回归分析，以确定方案参数对 CT-ECV 异质性的贡献。
13 项研究共有 248 名健康参与者接受了 CT-ECV 评估。健康参与者的 CT-ECV 方案参数存在较大差异。健康参与者的 CT-ECV 汇总估计值为 27.6%（95%CI 25.7%-29.4%），存在显著异质性（I=93%），而淀粉样变性患者为 50.2%（95%CI 46.2%-54.2%），严重主动脉瓣狭窄患者为 31.2%（28.5%-33.8%），非缺血性扩张型心肌病患者为 36.9%（31.6%-42.3%）。荟萃回归显示，CT 方案参数约占 CT-ECV 估计值异质性的 25%。
文献中健康个体的 CT-ECV 估计值差异很大，与心脏疾病的估计值有很大重叠。这种异质性的四分之一可以用 CT-ECV 方案参数的差异来解释。为了广泛实施 CT-ECV 评估以进行诊断和预后，有必要对 CT-ECV 方案进行标准化。
