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T1 Mapping and Extracellular Volume in Dilated Cardiomyopathy
Quick Takes
- Noninvasive assessment of myocardial fibrosis using native myocardial T1 mapping and the extracellular volume (ECV) fraction might improve risk stratification of patients with dilated cardiomyopathy (DCM), especially in patients with negative late gadolinium enhancement (LGE).
- The amount of LGE had the strongest association with outcomes in patients with DCM with positive LGE on CMR imaging.
- A combined assessment with T1 mapping, ECV fraction, and LGE may be helpful for optimal risk stratification of patients with DCM, but requires additional validation given the single-center and retrospective nature of the current analysis.
Study Questions:
What is the prognostic value of T1 mapping and the extracellular volume (ECV) fraction in patients with dilated cardiomyopathy (DCM)?
Methods:
The investigators enrolled a total of 659 consecutive patients with DCM (498 men; 45 ± 15 years) who underwent cardiac magnetic resonance (CMR) with T1 mapping and late gadolinium enhancement (LGE) imaging with a 1.5-T magnetic resonance scanner in this study. Primary endpoints were cardiac-related death and heart transplantation. Secondary endpoints were hospitalization for heart failure, ventricular arrhythmias, and implantable cardioverter-defibrillator or cardiac resynchronization therapy implantation. Survival estimates were calculated by Kaplan-Meier curves with the log-rank test.
Results:
During a mean follow-up of 66.3 ± 20.9 months, 122 and 205 patients with DCM reached the primary and secondary endpoints, respectively. The presence of LGE had an association with both of the primary and secondary endpoints observed in the patients with DCM (both p < 0.001). The maximum native T1 (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.09) and maximum ECV fraction (HR, 1.14; 95% CI, 1.08-1.21) had associations with the primary endpoints in the patients with positive LGE (both p < 0.001), whereas the mean native T1 (HR, 1.13; 95% CI, 1.10-1.36) and mean ECV fraction (HR, 1.32; 95% CI, 1.12-1.53) had the best associations in the patients with negative LGE (all p < 0.001).
Conclusions:
The authors concluded that T1 mapping and the ECV fraction had prognostic value in patients with DCM and were particularly important in patients with DCM without LGE.
Perspective:
This study suggests that noninvasive assessment of myocardial fibrosis using native myocardial T1 mapping and the ECV fraction might improve risk stratification of patients with DCM, especially in patients with negative LGE. This study also confirmed the prognostic value of LGE and found that the amount of LGE had the strongest association with outcomes in patients with DCM with positive LGE on CMR imaging. A combined assessment with T1 mapping, the ECV fraction, and LGE may be helpful for optimal risk stratification of patients with DCM, but requires additional validation given the single-center and retrospective nature of the current analysis.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Imaging, Magnetic Resonance Imaging
Keywords: Arrhythmias, Cardiac, Cardiac Resynchronization Therapy, Cardiomyopathy, Dilated, Defibrillators, Implantable, Diagnostic Imaging, Fibrosis, Gadolinium, Heart Failure, Heart Transplantation, Magnetic Resonance Imaging, Risk Assessment, Secondary Prevention
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