Background: Photon-counting computed tomography (PCCT) combines high spatial resolution with spectral imaging and can provide morphologic, functional, and tissue assessment in hypertrophic hearts. Objectives: The authors investigated whether PCCT characterizes left ventricular hypertrophy (LVH) as accurately as cardiac magnetic resonance (CMR) overall and across hypertrophic phenotypes. Methods: Consecutive patients with LVH (n = 182; 72 with hypertrophic cardiomyopathy, 47 with amyloid transthyretin cardiomyopathy, and 63 with secondary LVH) underwent PCCT including late iodine enhancement (LIE) and PCCT-derived extracellular volume (ECV). Eighty-three patients (46%) also underwent CMR within ±12 months (median interval: −12 days). Agreement was assessed for morphofunctional indices, ECV, and LIE vs late gadolinium enhancement (LGE). Results: PCCT differentiated etiologies through distinctive tissue patterns. Transthyretin cardiac amyloidosis showed the highest left ventricular mass index (median: 104 g/m2), the greatest LIE extent (median: 17/17 segments), and the highest ECV (median: 47%). Hypertrophic cardiomyopathy showed patchy fibrosis (median 4 enhanced segments) with intermediate ECV (31%), whereas secondary LVH displayed minimal enhancement (median: 0 segments) and the lowest ECV (28%). In paired examinations, PCCT correlated closely with CMR for left ventricular mass index and left ventricular ejection fraction (r = 0.963 and r = 0.947; P < 0.001 for both) and for ECV (r = 0.868; P < 0.001). LIE extent strongly agreed with LGE extent (r = 0.998; P < 0.001); segment-wise LIE/LGE agreement was 99% to 100%, and PCCT detected CMR-LGE with excellent accuracy (AUC: 0.994; sensitivity 99%; specificity 100%). Global PCCT-derived ECV showed excellent inter-reader agreement (ICC: 0.98). Conclusions: PCCT provides CMR-comparable assessment of ventricular geometry, function, and myocardial fibrosis/ECV while enabling coronary angiography, supporting its use when CMR is contraindicated, impractical, or nondiagnostic.
Photon-Counting Computed Tomography for Tissue Characterization in Patients With a Left Ventricular Hypertrophic Phenotype / De Gori, C., Aimo, A., Occhipinti, M., Muca, M., Pignatelli, F., Coscarelli, A., Castiglione, V., Grigoratos, C., Ferrari Chen, Y.F., Campora, A., Gueli, I.A., Barison, A., Pieroni, M., Olivotto, I., Aquaro, G.D., Emdin, M., Vergaro, G., Todiere, G., Clemente, A.. - In: JACC. CARDIOVASCULAR INTERVENTIONS. - ISSN 1876-7591. - ELETTRONICO. - 19:(2026), pp. 838-852. [10.1016/j.jcmg.2026.02.019]
Photon-Counting Computed Tomography for Tissue Characterization in Patients With a Left Ventricular Hypertrophic Phenotype
Occhipinti, Mariaelena;Coscarelli, Antonio;Castiglione, Vincenzo;Pieroni, Maurizio;Olivotto, Iacopo;Vergaro, Giuseppe;
2026
Abstract
Background: Photon-counting computed tomography (PCCT) combines high spatial resolution with spectral imaging and can provide morphologic, functional, and tissue assessment in hypertrophic hearts. Objectives: The authors investigated whether PCCT characterizes left ventricular hypertrophy (LVH) as accurately as cardiac magnetic resonance (CMR) overall and across hypertrophic phenotypes. Methods: Consecutive patients with LVH (n = 182; 72 with hypertrophic cardiomyopathy, 47 with amyloid transthyretin cardiomyopathy, and 63 with secondary LVH) underwent PCCT including late iodine enhancement (LIE) and PCCT-derived extracellular volume (ECV). Eighty-three patients (46%) also underwent CMR within ±12 months (median interval: −12 days). Agreement was assessed for morphofunctional indices, ECV, and LIE vs late gadolinium enhancement (LGE). Results: PCCT differentiated etiologies through distinctive tissue patterns. Transthyretin cardiac amyloidosis showed the highest left ventricular mass index (median: 104 g/m2), the greatest LIE extent (median: 17/17 segments), and the highest ECV (median: 47%). Hypertrophic cardiomyopathy showed patchy fibrosis (median 4 enhanced segments) with intermediate ECV (31%), whereas secondary LVH displayed minimal enhancement (median: 0 segments) and the lowest ECV (28%). In paired examinations, PCCT correlated closely with CMR for left ventricular mass index and left ventricular ejection fraction (r = 0.963 and r = 0.947; P < 0.001 for both) and for ECV (r = 0.868; P < 0.001). LIE extent strongly agreed with LGE extent (r = 0.998; P < 0.001); segment-wise LIE/LGE agreement was 99% to 100%, and PCCT detected CMR-LGE with excellent accuracy (AUC: 0.994; sensitivity 99%; specificity 100%). Global PCCT-derived ECV showed excellent inter-reader agreement (ICC: 0.98). Conclusions: PCCT provides CMR-comparable assessment of ventricular geometry, function, and myocardial fibrosis/ECV while enabling coronary angiography, supporting its use when CMR is contraindicated, impractical, or nondiagnostic.
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