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T1 Mapping and Extracellular Volume Fraction in Dilated Cardiomyopathy: A Prognosis Study
Shuang Li1, Di Zhou1, Arlene Sirajuddin2
1Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
T1 mapping and extracellular volume (ECV) fraction improve risk stratification for dilated cardiomyopathy (DCM) patients. These noninvasive methods are especially valuable for patients without late gadolinium enhancement (LGE), offering better prognostic insights.
Area of Science:
- Cardiology
- Radiology
- Biomedical Imaging
Background:
- Dilated cardiomyopathy (DCM) patients with left ventricular remodeling face poorer prognoses.
- Noninvasive assessment of myocardial fibrosis using T1 mapping and ECV fraction may enhance risk stratification in DCM.
- Systematic evaluation of T1 mapping and ECV fraction for DCM prognostication is needed.
Purpose of the Study:
- To examine the prognostic value of T1 mapping and extracellular volume (ECV) fraction in patients with dilated cardiomyopathy (DCM).
Main Methods:
- 659 DCM patients underwent cardiac MRI with T1 mapping and late gadolinium enhancement (LGE) imaging.
- Primary endpoints included cardiac death and heart transplantation.
- Secondary endpoints comprised heart failure hospitalization, arrhythmias, and device implantation.
Main Results:
- LGE was associated with both primary and secondary endpoints (P < 0.001).
- Maximum native T1 and ECV fraction correlated with primary endpoints in LGE-positive patients (P < 0.001).
- Mean native T1 and ECV fraction showed the strongest association with primary endpoints in LGE-negative patients (P < 0.001).
Conclusions:
- T1 mapping and ECV fraction possess prognostic value in DCM, particularly in patients without LGE.
- Combining T1 mapping, ECV fraction, and LGE offers optimal risk stratification for DCM patients.
Objectives:
The aim of this study is to examine the prognostic value of T1 mapping and the extracellular volume (ECV) fraction in patients with dilated cardiomyopathy (DCM).
Background:
Patients with DCM with functional left ventricular remodeling have poorer prognoses. Noninvasive assessment of myocardial fibrosis using T1 mapping and the ECV fraction may improve risk stratification of patients with DCM; however, this has not yet been systematically evaluated.
Methods:
A total of 659 consecutive patients with DCM (498 men; 45 ± 15 years) who underwent cardiac magnetic resonance with T1 mapping and late gadolinium enhancement (LGE) imaging with a 1.5-T magnetic resonance scanner were enrolled 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 (HR: 1.04; 95% 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:
T1 mapping and the ECV fraction had prognostic value in patients with DCM and were particularly important in patients with DCM without LGE. Using a combination of T1 mapping, ECV fraction, and LGE provided optimal risk stratification for patients with DCM.
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