Each 10ms increase in native T1 was independently associated with an 11% higher risk of death or heart failure, outperforming ECV in risk prediction (HR 1.11, p<0.001).
Does native T1 mapping improve risk prediction compared to ECV in patients referred for clinical CMR?
Native T1 mapping is an independent risk predictor superior to ECV, providing incremental prognostic value beyond LVEF and GLS in an unselected clinical population, potentially justifying non-contrast CMR protocols.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Left ventricular ejection fraction (LVEF) is commonly used for risk assessment in cardiovascular diseases (CVD). Despite limitations of LVEF, deformation imaging also remains underused, amongst others due to inter-vendor variability. Meanwhile tissue characterisation has been recognised as an additional assessment tool. Consequently, we sought to investigate the significance and relative merit of native T1 and extracellular volume (ECV) in an unselected clinical routine population. Methods The single-center cardiovascular magnetic resonance (CMR) registry prospectively included patients referred for clinical CMR. Ventricular volumetric analyses were performed on short axis (SAX) stacks. LV global longitudinal strain (GLS) was evaluated on long axis views. Native T1 and ECV were assessed on septal basal or midventricular SAX positions. A follow-up was conducted for the primary (all-cause mortality and heart failure hospitalisation) and secondary endpoint (all-cause mortality, hospitalised angina, infarction and stroke). Results The final population consisted of n=1633 patients classified as normal (n=450), chronic coronary syndrome (n=309), ischaemic heart disease (n=275), dilated (n=233), hypertrophic (n=37) or other (n=22) cardiomyopathies, hypertensive heart disease (n=28), storage disorders (n=8), inflammation (n=101), acute myocardial injury (n=11), right heart failure (n=17) and others (n=142). In total n=68 primary and n=106 secondary endpoints were seen during the median follow-up of 395 days. An increase in native T1 of 10ms was associated with a HR of 1.11, 95% CI 1.07-1.15, p0.001 for the primary endpoint independent of ECV (p=0.738). T1 (HR 1.07, 95% CI 1.03-1.11, p=0.001) but not ECV (p=0.674) was an independent predictor for the primary endpoint after correction for commonly considered risk factors including age, NYHA class, biomarker NTproBNP/glomerular filtration rate and GLS. After dichotomisation at the median of 1126 ms, T1 added incremental value for primary endpoint prediction on Kaplan Meier plots and associated log-rank testing in patients with EF above (p= 0.019) and below (p=0.017) the median of 55% as well as GLS above (p= 0.019) and below (p=0.041) the median of -16.4%. Conclusion Native T1 emerges as an independent risk predictor compared to ECV with incremental prognostic value in addition to LVEF and GLS. This finding may justify non-contrast CMR protocols in selected patients.
Backhaus et al. (Sat,) reported a other. Each 10ms increase in native T1 was independently associated with an 11% higher risk of death or heart failure, outperforming ECV in risk prediction (HR 1.11, p<0.001).