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Hepatic T1-Time Predicts Cardiovascular Risk in All-Comers Referred for Cardiovascular Magnetic Resonance: A Post-Hoc
Katharina Mascherbauer1, Carolina Donà1, Matthias Koschutnik1
1Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna.
Insights
Liver T1-times measured during cardiac MRI can indicate liver damage in cardiovascular disease patients. Elevated liver T1-times predict increased risk of adverse cardiovascular events.
Area of Science:
- Cardiology
- Radiology
- Hepatology
Background:
- Liver damage is common in cardiovascular disease (CVD) but often unquantified.
- Cardiac magnetic resonance (CMR) can assess liver T1-times, potentially indicating liver damage.
- This study investigates the link between liver T1-times and cardiovascular outcomes.
Purpose of the Study:
- To determine if liver T1-times measured during CMR correlate with liver damage.
- To assess the association between liver T1-times and cardiovascular outcomes in patients with CVD.
Main Methods:
- Hepatic T1-times were measured using standard cardiac T1-maps in a CMR cohort.
- Liver fibrosis scores were assessed at the time of CMR.
- Kaplan-Meier and Cox-regression analyses evaluated the association between liver T1-times and a composite endpoint of cardiovascular events.
Main Results:
- Liver T1-times were significantly correlated with cardiac function, atrial fibrillation, and NT-pro-BNP levels.
- High hepatic T1-times were independently associated with a higher risk of cardiovascular events (adjusted HR 1.66 per 100 ms increase).
- A hepatic T1-time exceeding 610 ms indicated excessive cardiovascular risk.
Conclusions:
- Hepatic T1-times from standard CMR scans are linked to cardiac status and comorbidities.
- Liver T1-times independently predict cardiovascular morbidity and mortality.
- A hepatic T1-time threshold of 610 ms may identify patients at high risk.
Background:
Liver damage is frequently observed in patients with cardiovascular disease but infrequently quantified. We hypothesized that in patients with cardiovascular disease undergoing cardiac magnetic resonance, liver T1-times indicate liver damage and are associated with cardiovascular outcome.
Methods:
We measured hepatic T1-times, displayed on standard cardiac T1-maps, in an all-comer cardiac magnetic resonance-cohort. At the time of cardiac magnetic resonance, we assessed validated general liver fibrosis scores. Kaplan-Meier estimates and Cox-regression models were used to investigate the association between hepatic T1-times and a composite endpoint of non-fatal myocardial infarction, heart failure hospitalization, and death.
Results:
One thousand seventy-five participants (58±18 year old, 47% female) were included (972 patients, 50 controls, 53 participants with transient elastography). Hepatic T1-times were 590±89 ms in patients and 574±45 ms in controls (P=0.052). They were significantly correlated with cardiac size and function, presence of atrial fibrillation, NT-pro-BNP levels, and gamma-glutamyl-transferase levels (P<0.001 for all). During follow-up (58±31 months), a total of 280 (29%) events occurred. On Cox-regression, high hepatic T1-times yielded a significantly higher risk for events (adjusted hazard ratio, 1.66 [95% CI, 1.45-1.89] per 100 ms increase; P<0.001), even when adjusted for age, sex, left and right ventricular ejection fraction, NT-proBNP (N-terminal prohormone of brain natriuretic peptide), and myocardial T1-time. On receiver operating characteristic analysis and restricted cubic splines, we found that a hepatic T1-time exceeding 610 ms was associated with excessive risk.
Conclusions:
Hepatic T1-times on standard cardiac magnetic resonance scans were significantly associated with cardiac size and function, comorbidities, natriuretic peptides, and independently predicted cardiovascular mortality and morbidity. A hepatic T1-time >610 ms seems to indicate excessive risk.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT04220450.
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