February 9, 2024IJC Heart & VasculatureOpen Access

Utility of native T1 mapping and myocardial extracellular volume fraction in patients with nonischemic dilated cardiomyopathy: A systematic review and meta-analysis

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Why the study?

The study aimed to characterize the utility of CMR-based native T1 mapping and ECV in patients with non-ischemic cardiomyopathy and clarify the prognostic significance of elevated values.

Do CMR-based native T1 mapping and ECV measurement predict major adverse cardiac events, ventricular arrhythmias, and left ventricular reverse remodeling in patients with non-ischemic cardiomyopathy?

Structured PICO

Do CMR-based native T1 mapping and ECV measurement predict major adverse cardiac events, ventricular arrhythmias, and left ventricular reverse remodeling in patients with non-ischemic cardiomyopathy?

Population

Patients with non-ischemic cardiomyopathy (NICM)

Intervention

CMR-based native T1 mapping and extracellular volume (ECV) measurement

Comparator

Controls (for baseline comparison) and NICM patients without adverse events or with good treatment response

Outcome

Major adverse cardiac events (MACE), ventricular arrhythmias (VAs), and left ventricular reverse remodeling (LVRR)composite

CMR-based native T1 mapping and ECV quantification are significantly elevated in NICM patients and are associated with MACE and poor treatment response, suggesting utility for risk stratification.

Implication

Elevated native T1 and ECV may aid MACE risk stratification in NICM; leaves open prospective validation before guiding therapy.

Abstract

Background: -analysis aims to characterize the utility of native T1 mapping and ECV in patients with non-ischemic cardiomyopathy (NICM) and to clarify the prognostic significance of elevated values. Methods: A literature search was conducted for studies reporting on use of CMR-based native T1 mapping and ECV measurement in NICM patients and their association with major adverse cardiac events (MACE), ventricular arrhythmias (VAs), and left ventricular reverse remodeling (LVRR). Databases searched included: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results: Native T1 and ECV were significantly higher in NICM patients compared to controls (MD 78.80, 95 % CI 50.00, 107.59; p < 0.01; MD 5.86, 95 % CI 4.55, 7.16; p < 0.01). NICM patients who experienced MACE had higher native T1 and ECV (MD 52.87, 95 % CI 26.59, 79.15; p < 0.01; MD 6.03, 95 % CI 3.79, 8.26; p < 0.01). There was a non-statistically significant trend toward higher native T1 time in NICM patients who experienced VAs. NICM patients who were poor treatment responders had higher baseline native T1 and ECV (MD 40.58, 95 % CI 12.90, 68.25; p < 0.01; MD 3.29, 95 % CI 2.25, 4.33; p < 0.01). Conclusions: CMR-based native T1 and ECV quantification may be useful tools for risk stratification of patients with NICM. They may provide additional diagnostic utility in combination with LGE, which poorly characterizes fibrosis in patients with diffuse myocardial involvement.