Photon-counting computed tomography for tissue characterization in patients with left ventricular hypertrophy

Abstract Background Photon-counting computed tomography (PCCT) has emerged as a promising modality for cardiac imaging. In patients with left ventricular hypertrophy (LVH), PCCT may offer an alternative to cardiac magnetic resonance (CMR), which is contraindicated or unavailable in some individuals. Methods We prospectively evaluated 79 patients presenting with LVH. Each underwent a PCCT scan, with measurements including LV mass index (LVMI), maximal LV wall thickness, ejection fraction (EF), late iodine enhancement (LIE) extent, iodine density, and extracellular volume (ECV). Patients were classified into three groups: hypertrophic cardiomyopathy (HCM, n=30), amyloid transthyretin cardiomyopathy (ATTR-CM, n=27), and secondary LV hypertrophy (LVH, n=24). A subset (43%) underwent a clinically indicated CMR scan within three months of PCCT. Results We evaluated 30 patients with HCM, 27 with ATTR-CM, and 24 with secondary LVH. Significant differences between groups emerged in patient age (66 years [55-73] vs. 80 [74-83] vs. 74 [66-81], respectively; p