Abstract 15154: T1-mapping and Outcomes in Non-ischemic Cardiomyopathies- An Investigator-led Multicenter Observational Longitudinal Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Valentina O Puntmann ◽  
Gerry Carr-White ◽  
Andrew Jabbour ◽  
Chung-Yao Yu ◽  
Rolf Gebker ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Risk Stratification ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Independent Predictor ◽  
Reference Ranges ◽  
Non Invasive ◽  
Native T1 ◽  
All Cause Mortality ◽  
Interstitial Myocardial Fibrosis

Introduction: Nonischemic cardiomyopathy (NICM) is a recognised cause of poor clinical outcome. NICM is characterised by intrinsic myocardial impairment, which is driven by interstitial myocardial fibrosis in a considerable majority of NICM. The lack of accurate and noninvasive characterisation of interstitial myocardial fibrosis limits recognition of disease and effective clinical management in NICM. Hypothesis: T1 mapping by CMR is a novel non-invasive imaging application with a recognized potential to significantly improve the management of patients with NICM, supporting characterization of interstitial myocardial disease, assessment of severity of disease, risk stratification as well as development of targeted therapies. Comparative prognostic relevance of T1-mapping parameters in subjects with NICM for adverse outcome is unknown. Methods: an investigator-led multicenter observational longitudinal study in patients with NICM. We standardized imaging acquisition based on the modified Look-Locker sequence (MOLLI) (3(3)3(3)5) and post-processing approach of T1 mapping, and transferred the methodology to several other centres. We determined reference ranges for T1 mapping values and provided proof of concept studies in NICM in discrimination between health and disease. The primary endpoint was all-cause mortality. Results: 805 consecutive patients (mean age (years) 50±16; males: n=499, 62%) with NICM underwent contrast-enhanced CMR with T1-mapping. During a median follow-up period of 17 months (range 36 months), we observed a total of 26 deaths (18 cardiac). Native T1, ECV and extent of LGE were strongly associated with an increased likelihood of all-cause mortality (p<0.001). In multivariate analyses, native T1 was the sole independent predictor of all-cause and cardiac mortality, over and above ECV and LGE. Native T1 was also superior in correctly classifying subjects and adverse events over a 17-months period. Conclusions. In patients with NICM, non-invasive measures of interstitial myocardial fibrosis are useful in prediction of outcome. Native T1 is an independent predictor over and above conventional markers of risk, providing a basis for a novel algorithm of risk stratification in NICM.

scholarly journals REFERENCE RANGES OF NATIVE T1-MAPPING AND EXTRACELLULAR VOLUME FOR CARDIAC AMYLOIDOSIS - A META-ANALYSIS

2021 ◽  
Vol 77 (18) ◽  
pp. 1312
Author(s):  
Tom Kai Ming Wang ◽  
Maria Vega Brizneda ◽  
Deborah Kwon ◽  
Zoran Popovic ◽  
Scott Flamm ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
T1 Mapping ◽  
Meta Analysis ◽  
Extracellular Volume ◽  
Reference Ranges ◽  
Native T1

scholarly journals Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pankaj Garg ◽  
Hosamadin Assadi ◽  
Rachel Jones ◽  
Wei Bin Chan ◽  
Peter Metherall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Native T1 ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

scholarly journals Association between Native Myocardial T1 Mapping and Cardiac Function and Macroscopic Fibrosis in Thalassemia Major

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Alessia Pepe ◽  
Nicola Martini ◽  
Antonio De Luca ◽  
Vincenzo Positano ◽  
Laura Pistoia ◽  
...  
Keyword(s):  
Iron Overload ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Lv Function ◽  
Myocardial Iron ◽  
Native T1 ◽  
Molli Sequence ◽  
Lv Volume

Background.Cardiovascular magnetic resonance (CMR) is the only available technique for the non-invasive quantification of MIO. The native T1 mapping has recently been proposed as an alternative to the universally adopted T2* technique, due to the higher sensitivity for detection of changes associated with mild or early iron overload. Objective.To study the association between T1 values and left ventricular (LV) function in thalassemia major (TM) and to evaluate for the first time if T1 measurements quantifying MIO are influenced by macroscopic myocardial fibrosis. Methods.146 TM patients (87 females, 38.7±11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network underwent CMR. Native T1 values were obtained by Modified Look-Locker Inversion recovery (MOLLI) sequence in all 16 myocardial segments and the global value was the mean. LV function parameters were quantified by cine images. Late gadolinium enhancement (LGE) technique was used to detect macroscopic myocardial fibrosis. Results.No correlation was detected between global heart T1 values and LV volume indexes, LV mass index, or LV ejection fraction. Foourteen (9.6%) patients had an abnormal LV motion (13 hypokinesia and 1 dyskinesia) and they showed significantly lower global heart T1 values than patients without LV motion abnormalities (883.8±139.7 ms vs 959.0±91.3 ms; P=0.049). LGE images were acquired in 88 patients (60.3%) and macroscopic myocardial fibrosis was detected in 36 patients (40.9%). The 72.2% of patients had two or more foci of fibrosis. Patients with macroscopic myocardial fibrosis had significantly lower global heart T1 values (921.3±100.3 ms vs 974.5±72.7 ms; P=0.027) (Figure 1A). Data about the LGE was present for 1408 segments (88 patients x 16 segments) and 105 (7.5%) were positive. Segments with LGE had significantly lower T1 values than segments LGE-negative (905.6±110.6 ms vs 956.9±103.8 ms; P&lt;0.0001) (Figure 1B). Conclusion.No correlation between T1 values and LV function parameters was detected, probably because the majority of the patients had normal or mild abnormal LV parameters. TM patients with macroscopic myocardial fibrosis showed significantly lower T1 values suggesting that T1 measurements for quantifying MIO are not influenced by macroscopic myocardial fibrosis and an association between myocardial iron and macroscopic fibrosis, previously detected only in pediatric TM patients. Figure Disclosures Pepe: Chiesi Farmaceutici S.p.A.:Other: no profit support and speakers' honoraria;Bayer:Other: no profit support;ApoPharma Inc.:Other: no profit support.Pistoia:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.Meloni:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.

scholarly journals RETRACTED ARTICLE: Prognostic value of heart failure in hemodialysis-dependent end-stage renal disease patients with myocardial fibrosis quantification by extracellular volume on cardiac magnetic resonance imaging

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hua-yan Xu ◽  
Zhi-gang Yang ◽  
Yi Zhang ◽  
Wan-lin Peng ◽  
Chun-chao Xia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Fibrosis ◽  
Prognostic Value ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Cardiac Events ◽  
Native T1 ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients are at high cardiovascular risk, and myocardial fibrosis (MF) accounts for most of their cardiac events. The purpose of this study is to investigate the prognostic value and risk stratification of MF as measured by extracellular volume (ECV) on cardiac magnetic resonance (CMR) for heart failure (HF) in patients with hemodialysis-dependent ESRD. Methods Sixty-six hemodialysis ESRD patients and 25 matched healthy volunteers were prospectively enrolled and underwent CMR to quantify multiple parameters of MF by T1 mapping and late gadolinium enhancement (LGE). All ESRD patients were followed up for 11–30 months, and the end-point met the 2016 ESC guidelines for the definition of HF. Results Over a median follow-up of 18 months (range 11–30 months), there were 26 (39.39%) guideline-diagnosed HF patients in the entire cohort of ESRD subjects. The native T1 value was elongated, and ECV was enlarged in the HF cohort relative to the non-HF cohort and normal controls (native T1, 1360.10 ± 50.14 ms, 1319.39 ± 55.44 ms and 1276.35 ± 56.56 ms; ECV, 35.42 ± 4.42%, 31.85 ± 3.01% and 26.97 ± 1.87%; all p<0.05). In the cardiac strain analysis, ECV was significantly correlated with global radial strain (GRS) (r = − 0.501, p = 0.009), global circumferential strain (GCS) (r = 0.553, p = 0.005) and global longitudinal strain (GLS) (r = 0.507, p = 0.008) in ESRD patients with HF. Cox proportional hazard regression models revealed that ECV (hazard ratio [HR] = 1.160, 95% confidence interval: 1.022 to 1.318, p = 0.022) was the only independent predictor of HF in ESRD patients. It also had a higher diagnostic accuracy for detecting MF (area under the curve [AUC] = 0.936; 95% confidence interval: 0.864 to 0.976) than native T1 and post T1 (all p ≤ 0.002). Kaplan-Meier analysis revealed that the high-ECV group had a shorter median overall survival time than the low-ECV group (18 months vs. 20 months, log-rank p = 0.046) and that ESRD patients with high ECV were more likely to have HF. Conclusions Myocardial fibrosis quantification by ECV on CMR T1 mapping was shown to be an independent risk factor of heart failure, providing incremental prognostic value and risk stratification for cardiac events in ESRD patients. Trial registration Chinese Clinical Trial Registry ChiCTR-DND-17012976, 13/12/2017, Retrospectively registered.

Abstract 12759: Diagnostic and Prognostic Utility of T1 Mapping and Extracellular Volume by Magnetic Resonance Imaging for Cardiac Amyloidosis: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Maria Vega Brizneda ◽  
Deborah H Kwon ◽  
Scott D Flamm ◽  
Mazen A Hanna ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cardiac Amyloidosis ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Resonance Imaging ◽  
Detection Rates ◽  
Native T1 ◽  
Continuous Parameter ◽  
All Cause Mortality

Background: Cardiac magnetic resonance imaging (CMR) is central to the evaluation of cardiac amyloidosis (CA). Native T1 mapping and extracellular volume (ECV) are novel CMR techniques with evolving utility in cardiovascular diseases including CA. This study aims to meta-analyze the diagnostic and prognostic data of native T1 mapping and extracellular volume (ECV) techniques for assessing CA. Methods: Pubmed, Cochrane and Embase were searched until 31 March 2020 for studies reporting the accuracy of native T1 mapping and ECV for diagnosing CA or predicting all-cause mortality. Area under the receiver-operative characteristics curves (AUC) and hazards ratios (HR) with 95% confidence intervals (95% CI) respectively were pooled using random-effects models and Open-Meta(Analyst) software. Results: Amongst 459 records obtained from the literature search, 41 full-text articles were assessed and 10 studies were eligible totalling 2364 subjects and 1528 patients with confirmed CA. Pooled AUCs (95% CI) for diagnosing CA were 0.924 (0.889-0.959) for native T1 mapping and 0.963 (0.925-1.000) for ECV (Figure panel A/B). Both techniques had similarly high detection rates for AL- and ATTR CA (pooled AUCs of 0.935 and 0.916 for native T1 mapping and 0.980 and 0.952 for ECV). Pooled HRs (95% CI) for predicting all-cause mortality were 1.15 (1.08-1.22) for native T1 mapping as a continuous parameter, 1.19 (1.01-1.40) for ECV as a continuous parameter (Figure panel C/D), and 4.93 (2.64-9.20) for ECV as a binary threshold. Conclusion: Both native T1 mapping and ECV had high diagnostic performance for CA and predicted all-cause mortality after CA. These CMR techniques can play important roles in the multi-modality imaging assessment of CA, including when contrast administration is contraindicated.

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