Cardiac T1 mapping enables risk prediction of LV dysfunction after surgery for aortic regurgitation

Figures

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  Figure 1. Flow diagram of inclusion and exclusion criteria. Patients with aortic valve disease that underwent preoperative MRI, echocardiography, and follow-up echocardiography after aortic valve surgery were included. Patients were separated into two groups after surgery based on the comparison of echocardiography-derived preoperative and postoperative left ventricular ejection fractions (LVEF): LVEF was defined as preserved if the change were <−10% and as decreased if the changes were ≥−10%.

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  Figure 2. Course of the LVEF in patients with preserved and reduced LVEF. Twenty-five patients with aortic regurgitation showed a preserved postoperative LVEF with a postoperative change of less than −10%. On the other hand, fifteen patients developed a reduced postoperative LVEF, which declined by more than −10%.

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  Figure 3. Comparison of preoperative parametric MR maps between patients with preserved and decreased LVEF after aortic valve surgery. In a 69-year-old TAV patient with post-operatively preserved LVEF (+2% change), preoperative native T1 and ECV showed normal values (1,003 ms and 26%). In contrast, in a 49-year-old BAV patient with post-operatively decreased LVEF (−15% change), native T1-map was prolonged (1,112 ms) and ECV-map was increased (30%). The black-outlined polygon illustrates a representative region of interest (ROI), demonstrating how parametric values were obtained. ECV, extracellular volume, LVEF, left ventricular ejection fraction.

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  Figure 4. Comparison of preoperative parametric MR mapping in 40 patients with aortic regurgitation. (A) Preoperative native T1-times are significantly higher in regurgitation patients with post-operatively decreased LVEF vs. patients with post-operatively preserved LVEF. (B) Preoperative ECV does not significantly differ between patients with decreased vs. preserved LVEF. LVEF, left ventricular ejection fraction, ECV, extracellular volume.

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  Figure 5. ROC analysis revealed that native T1 had the best performance with an AUC of 0.820 (95% CI: 0.683–0.958) to identify aortic regurgitation patients with early decreased LVEF after aortic valve surgery, whereas ECV had a lower AUC of 0.582 (95% CI: 0.380–0.783). A T1 time ≥1,053 ms achieved a sensitivity of 70% and specificity of 84% to differentiate between patients with preserved and decreased LVEF.