Myocardial fibrosis by T1 mapping magnetic resonance imaging predicts incident cardiovascular events and all-cause mortality: the Multi-Ethnic Study of Atherosclerosis

Abstract

Aims To evaluate whether myocardial fibrosis predicts cardiovascular events (CVEs) and mortality in the Multi-Ethnic Study of Atherosclerosis. Methods and results Cardiac magnetic resonance (CMR) T1 mapping with gadolinium administration for assessment of extracellular volume fraction (ECV) was performed in 1326 participants, in whom myocardial scar was assessed by late gadolinium enhancement (LGE). The clinical outcomes were defined as all-cause mortality, atherosclerotic CVEs, and incident heart failure (HF) during an average of 8 years of follow-up after the scan. Participants’ mean native T1 time was 971 ms [standard deviation (SD) 45.5], ECV was 27 (SD 2.9), and 117 (8.8%) of them had LGE. At the time of the CMR exam, participant age was 68 years (SD 9) and 48% of them were women. Ideal cut-offs were identified using classification and regression trees accounting for time-to-event outcomes for ECV (30%) and native T1 time (954 ms). Over the follow-up period, 106 participants died, 78 developed CVE, and 23 developed HF. After adjustment for risk factors, ECV >30% was associated with death [hazard ratio (HR): 1.67, P < 0.05], incident CVE (HR: 2.02, P < 0.05), and incident HF (HR: 2.85, P < 0.05). After adjustments, native T1 >954 ms was associated with incident CVE (HR: 2.09, P < 0.05). Myocardial scar by LGE was not predictive of clinical outcomes after adjustments. Conclusion ECV is an independent prognostic marker of incident HF, atherosclerotic CVEs, and all-cause mortality. ECV, with its ability to characterize both diffuse and focal fibrosis processes, better predicted incident events than regional myocardial abnormalities as visualized by LGE imaging in a large multi-ethnic population.

Importance of cardiac imaging assessment of epicardial adipose tissue after a first episode of myocardial infarction

“…Patients with EAT >4mm had larger infarct size and longer native T1 values; both parameters were associated with the presence of lower LVEF and GLS in these patients. In the study published by Marques et al ( 22 ), native T1 times were associated with incident mortality and described a higher unadjusted cumulative survival probability in patients with native T1 <954 ms. Higher values of native T1 were associated with worse cardiovascular outcome and increased mortality rates. This study also showed that for every 10 ms increase in native T1, there was a higher hazard ratio for the prediction of mortality and MACE ( 22 ).…”

“…In the study published by Marques et al ( 22 ), native T1 times were associated with incident mortality and described a higher unadjusted cumulative survival probability in patients with native T1 <954 ms. Higher values of native T1 were associated with worse cardiovascular outcome and increased mortality rates. This study also showed that for every 10 ms increase in native T1, there was a higher hazard ratio for the prediction of mortality and MACE ( 22 ). T1 mapping has demonstrated the capability to accurately determine the amount of diffuse myocardial fibrosis; this diffuse fibrosis and changes in the ECV are more associated with poor outcome than focal fibrosis in different clinical scenarios ( 23 – 25 ).…”

Diffuse Myocardial Fibrosis on Cardiac Magnetic Resonance Imaging Is Related to Galectin-3 and Predicts Outcome in Heart Failure

“…This is in line with several studies emphasizing the prognostic importance of interstitial fibrosis in non-ischemic cardiomyopathy [ 23 , 24 ], and the non-infarcted myocardium [ 20 , 25 ] in coronary artery disease. A study by Marques and colleagues demonstrated that cardiac fibrogenesis even takes place and predicts prognosis in healthy individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) study [ 26 ]. A high native T1 time (pre-contrast, >984 ms) was associated with a 2.1-fold increased relative risk of new-onset CV events, while high extracellular volume (ECV > 30%) showed a 2.0 fold, 2.9 fold and 1.7 fold increased risk for new-onset CV events, new-onset HF and all-cause mortality, respectively.…”

The Depiction of Hypertension in Heart Imaging Examinations: An Up-to-Date Review of the Evidence

“… 49 The newly published Multi-Ethnic Study of Atherosclerosis proved that the extracellular volume fraction evaluated by CMR, and as so myocardial fibrosis, is an independent prognostic marker of incident HF, atherosclerotic CV events, and all-cause mortality. 50 Even more, it is highly correlated with sudden cardiac death. Finnish-autopsy proved data, investigating the reasons for sudden cardiac death in young subjects under the age of 40, revealed that primary myocardial fibrosis and HHD were some of the main reasons among the nonischemic causes.…”