Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated
Jiaqi Wang1, Yike Diao2, Yuanwei Xu1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Liver extracellular volume (ECV) measured via cardiac MRI is a strong independent predictor of adverse outcomes in nonischemic dilated cardiomyopathy (DCM) patients. This marker offers a novel approach for risk stratification in DCM.
Area of Science:
- Cardiovascular Imaging
- Hepatology
- Cardiology
Background:
- Hepatic alterations are common in heart failure (HF) and ventricular dysfunction.
- The prognostic significance of liver injury markers in nonischemic dilated cardiomyopathy (DCM) using cardiac MRI is not well-established.
Purpose of the Study:
- To evaluate the prognostic performance of liver injury markers derived from cardiac MRI in DCM patients.
- To assess the incremental value of liver parameters in risk stratification compared to conventional methods.
Main Methods:
- Prospective study of 356 DCM patients using 3T cardiac MRI, including T1 mapping and late gadolinium enhancement (LGE).
- Liver extracellular volume (ECV) and myocardial LGE were assessed.
- Survival analysis (Kaplan-Meier, Cox regression) was performed over a median follow-up of 48.3 months.
Main Results:
- Patients with elevated liver ECV (cut-off 34.4%) had a significantly higher risk of primary (HF death, sudden cardiac death, heart transplantation, HF readmission) and secondary endpoints.
- Liver ECV independently predicted primary endpoints and long-term HF readmission.
- Liver ECV demonstrated superior prognostic value compared to conventional clinical and cardiac MRI parameters.
Conclusions:
- Liver ECV measured by cardiac MRI is an independent prognostic predictor in DCM.
- Liver ECV represents an innovative tool for risk stratification in DCM patients.
Background:
Hepatic alterations are common aftereffects of heart failure (HF) and ventricular dysfunction. The prognostic value of liver injury markers derived from cardiac MRI studies in nonischemic dilated cardiomyopathy (DCM) patients is unclear.
Purpose:
Evaluate the prognostic performance of liver injury markers derived from cardiac MRI studies in DCM patients.
Study Type:
Prospective.
Population:
Three hundred fifty-six consecutive DCM patients diagnosed according to ESC guidelines (age 48.7 ± 14.2 years, males 72.6%).
Field Strength/Sequence:
Steady-state free precession, modified Look-Locker inversion recovery T1 mapping and phase sensitive inversion recovery late gadolinium enhancement (LGE) sequences at 3 T.
Assessment:
Clinical characteristics, conventional MRI parameters (ventricular volumes, function, mass), native myocardial and liver T1, liver extracellular volume (ECV), and myocardial LGE presence were assessed. Patients were followed up for a median duration of 48.3 months (interquartile range 42.0-69.9 months). Primary endpoints included HF death, sudden cardiac death, heart transplantation, and HF readmission; secondary endpoints included HF death, sudden cardiac death, and heart transplantation. Models were developed to predict endpoints and the incremental value of including liver parameters assessed.
Statistical Tests:
Optimal cut-off value was determined using receiver operating characteristic curve and Youden method. Survival analysis was performed using Kaplan-Meier and Cox proportional hazard. Discriminative power of models was compared using net reclassification improvement and integrated discriminatory index. P value <0.05 was considered statistically significant.
Results:
47.2% patients reached primary endpoints; 25.8% patients reached secondary endpoints. Patients with elevated liver ECV (cut-off 34.4%) had significantly higher risk reaching primary and secondary endpoints. Cox regression showed liver ECV was an independent prognostic predictor, and showed independent prognostic value for primary endpoints and long-term HF readmission compared to conventional clinical and cardiac MRI parameters.
Data Conclusions:
Liver ECV is an independent prognostic predictor and may serve as an innovative approach for risk stratification for DCM.
Evidence Level:
1 TECHNICAL EFFICACY: Stage 2.
