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Comparing CMR Mapping Methods and Myocardial Patterns Toward Heart Failure Outcomes in Nonischemic Dilated
Tomas Vita1, Christoph Gräni2, Siddique A Abbasi1
1Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Extracellular volume fraction (ECV) mapping in nonischemic dilated cardiomyopathy (NIDCM) predicts heart failure outcomes better than late gadolinium enhancement (LGE) or native T1 mapping. ECV mapping offers incremental prognostic value for major adverse cardiac events.
Area of Science:
- Cardiovascular Magnetic Resonance (CMR) imaging
- Cardiac tissue characterization
- Prognostic biomarkers in heart failure
Background:
- Late gadolinium enhancement (LGE) is a known prognostic indicator in nonischemic dilated cardiomyopathy (NIDCM), identified in 30% of patients.
- Existing prognostic tools for NIDCM may not fully capture the spectrum of myocardial changes.
Purpose of the Study:
- To evaluate the prognostic value of cardiac magnetic resonance (CMR) tissue-characterizing methods, including native T1, partition coefficient (λGd), and extracellular volume fraction (ECV) mapping, in patients with NIDCM.
- To compare the prognostic capabilities of ECV mapping against traditional LGE and native T1 mapping for predicting adverse cardiac events.
Main Methods:
- 240 NIDCM patients underwent CMR including cardiac function assessment, LGE, native T1, λGd, and ECV mapping across 6 anatomical locations.
- T1 mapping of myocardium and blood pool was performed before and after contrast administration.
- ECV was calculated from T1 values, adjusted for hematocrit, and correlated with major adverse cardiac events (MACE).
Main Results:
- Elevated ECV was observed in 58% of patients, while LGE was present in 34%.
- Mean ECV and λGd showed a strong association with MACE (p < 0.001).
- ECV mapping, particularly in the anteroseptum, demonstrated significant association with MACE and death, outperforming native T1 and LGE.
Conclusions:
- Myocardial ECV mapping provides prognostic information for heart failure outcomes in NIDCM patients.
- ECV mapping offers incremental prognostic value beyond LGE and native T1 mapping.
- The extent of ECV abnormality correlates with annual MACE rates and serves as an independent predictor of adverse events.
Objectives:
In patients with nonischemic dilated cardiomyopathy (NIDCM), native T1, partition coefficient (λGd), and extracellular volume fraction (ECV) mapping may offer prognostic values beyond late gadolinium enhancement (LGE), by scaling the range of myocardial changes.
Background:
In patients with NIDCM, LGE is seen in 30% of patients and it indicates adverse prognosis.
Methods:
The study mapped 6 anatomical locations using all 4 cardiac magnetic resonance (CMR) tissue-characterizing methods and associated with outcome. The authors performed T1 mapping of the myocardium and the blood pool, before and serially after contrast injection, using a Look-Locker cine gradient-echo technique to obtain T1 and the corresponding reciprocal R1 values. λGd values were derived from the slopes of the least-squares regression lines for myocardial versus blood R1, then adjusted to serum hematocrit to yield ECV.
Results:
Consecutive 240 NIDCM patients (49 ± 16 years of age; 38% women) underwent CMR for cardiac function, LGE, native T1, λGd, and ECV. After a median of 3.8 years, 36 (15%) experienced major adverse cardiac events (MACE), including 22 heart failure hospitalizations and 14 deaths. Nonischemic LGE was detected in 34%, whereas ECV was elevated (≥1 location) in 58%. Comparing the 4 methods, mean ECV and λGd both demonstrated strong association with MACE (both p < 0.001). In contrast to native T1 and LGE, ECV values from all 6 locations were associated with MACE and death, with the anteroseptum being the most significant (p < 0.0001). The number of abnormal ECV locations correlated linearly with annual MACE rates (p = 0.0003). Mean ECV was the only predictor to enter a prognostic model that contained age, sex, New York Heart Association functional class, and left ventricular ejection fraction. For every 10% increase, mean ECV portended to a 2.8-fold adjusted increase risk to MACE (p < 0.001).
Conclusions:
In this study of patients with NIDCM, mapping the myocardial extent of abnormality using ECV offers prognostication toward heart failure outcomes incremental to LGE or native T1 mapping.
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