Incremental Values of T1 Mapping in the Prediction of Sudden Cardiac Death Risk in Hypertrophic Cardiomyopathy: A
Le Qin1, Jiehua Min1, Chihua Chen1
1Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Native T1 mapping, a quantitative MRI measure, can predict major adverse cardiovascular events (MACE) in hypertrophic cardiomyopathy (HCM) patients. This technique offers added value beyond current risk stratification guidelines.
Area of Science:
- Cardiovascular Imaging
- Cardiology
- Biomedical Engineering
Background:
- Quantitative MRI parameters like native T1 mapping and extracellular volume fraction (ECV) offer insights into myocardial tissue characteristics.
- The predictive role of these quantitative MRI metrics for sudden cardiac death (SCD) risk in hypertrophic cardiomyopathy (HCM) remains incompletely understood.
Purpose of the Study:
- To evaluate the capability of native T1 mapping and ECV values in predicting major adverse cardiovascular events (MACE) in HCM patients.
- To assess the incremental predictive value of these parameters compared to existing 2014 European Society of Cardiology (ESC) and enhanced American College of Cardiology/American Heart Association (ACC/AHA) risk stratification guidelines.
Main Methods:
- Prospective enrollment of HCM patients and matched healthy controls undergoing cardiac MRI between July 2016 and October 2020.
- Measurement of native T1 and ECV parameters, alongside risk assessment using 2014 ESC and enhanced ACC/AHA guidelines.
- MACE definition included cardiac death, transplantation, heart failure admission, and implantable cardioverter-defibrillator implantation.
Main Results:
- A total of 203 HCM patients and 101 controls were analyzed; 25 HCM patients (12.3%) experienced MACE during a median 15-month follow-up.
- Global native T1 mapping (HR: 1.446) and non-sustained ventricular tachycardia (NSVT) (HR: 4.949) were independent predictors of MACE in multivariate analysis.
- Native T1 mapping showed independent association with MACE in patients stratified as low-risk by current guidelines (HR: 1.532) and in those with conflicting guideline risk assessments.
Conclusions:
- Global native T1 mapping demonstrates significant potential as an incremental prognostic marker for MACE in HCM.
- Native T1 mapping can serve as a valuable supplement to current risk stratification guidelines, enhancing the prediction of adverse cardiovascular events in HCM.
Abstract:
Background: MRI native T1 mapping and extracellular volume fraction (ECV) are quantitative values that could reflect various myocardial tissue characterization. The role of these parameters in predicting the risk of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is still poorly understood. Aim: This study aims to investigate the ability of native T1 mapping and ECV values to predict major adverse cardiovascular events (MACE) in HCM, and its incremental values over the 2014 European Society of Cardiology (ESC) and enhanced American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Methods: Between July 2016 and October 2020, HCM patients and healthy individuals with sex and age matched who underwent cardiac MRI were prospectively enrolled. The native T1 and ECV parameters were measured. The SCD risk was evaluated by the 2014 ESC guidelines and enhanced ACC/AHA guidelines. MACE included cardiac death, transplantation, heart failure admission, and implantable cardioverter-defibrillator implantation. Results: A total of 203 HCM patients (54.2 ± 14.9 years) and 101 healthy individuals (53.2 ± 14.7 years) were evaluated. During a median follow-up of 15 months, 25 patients (12.3%) had MACE. In multivariate Cox regression analysis, global native T1 mapping (hazard ratio (HR): 1.446; 95% confidence interval (CI): 1.195-1.749; P < 0.001) and non-sustained ventricular tachycardia (NSVT) (HR: 4.949; 95% CI, 2.033-12.047; P < 0.001) were independently associated with MACE. Ten of 86 patients (11.6%) with low SCD risk assessed by the two guidelines had MACE. In this subgroup of patients, multivariate Cox regression analysis showed that global native T1 mapping was independently associated with MACE (HR: 1.532; 95% CI: 1.221-1.922; P < 0.001). In 85 patients with conflicting results assessed by the two guidelines, end-stage systolic dysfunction was independently associated with MACE (HR: 7.942, 95% CI: 1.322-47.707, P = 0.023). In 32 patients with high SCD risk assessed by the two guidelines, NSVT was independently associated with MACE (HR: 9.779, 95% CI: 1.953-48.964, P = 0.006). Conclusion: The global native T1 mapping could provide incremental values and serve as potential supplements to the current guidelines in the prediction of MACE.
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