Routine Cardiac CT Enhanced to Predict Heart Failure Risk

Clinicians need reliable ways to detect myocardial injury early and stratify risk to prevent hospitalization and death. Standard cardiac computed tomography (CT) is widely available but is typically used to evaluate coronary arteries rather than myocardial health. Researchers have now shown that a routinely performed CT, enhanced with a brief delayed imaging phase, can flag patients at highest risk well before symptoms arise.

Investigators at Kumamoto University (Kumamoto, Japan) report a cardiac CT protocol that adds a short delayed phase to routine coronary imaging to quantify myocardial tissue injury. The method derives two complementary markers from the same scan: Late Iodine Enhancement (LIE) and extracellular volume (ECV) fraction. This approach remains non-invasive and integrates into existing CT workflows without additional procedures.

LIE identifies localized scarring by highlighting regions that retain iodine contrast on delayed images. ECV fraction reflects diffuse, subtle myocardial damage distributed throughout the heart muscle. When interpreted together, these measures provide a synergistic view of focal and widespread injury within one exam, revealing pathology that standard coronary-focused CT may not capture.

In a study of 1,207 patients followed for an average of 26 months, the combined assessment of LIE and ECV stratified risk for adverse outcomes. Patients with abnormalities in both markers had a significantly higher likelihood of unplanned hospitalization or death. The analysis also identified individuals at elevated risk for future heart failure and mortality, indicating prognostic value beyond stenosis detection alone.

The findings are published in European Heart Journal - Cardiovascular Imaging. The investigators state that a single, delayed-phase cardiac CT can deliver prognostic information in a more accessible format than cardiac magnetic resonance imaging, while supporting earlier, targeted treatment decisions. This evolution of routine CT from an anatomic test to a prognostic tool could help bring subclinical myocardial injury to light before symptoms trigger emergent care.

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Kumamoto University