Prognostic value of cardiovascular magnetic resonance T1 mapping and extracellular volume fraction in nonischemic dilated cardiomyopathy

Abstract

Background Heart failure- (HF) and arrhythmia-related complications are the main causes of morbidity and mortality in patients with nonischemic dilated cardiomyopathy (NIDCM). Cardiovascular magnetic resonance (CMR) imaging is a noninvasive tool for risk stratification based on fibrosis assessment. Diffuse interstitial fibrosis in NIDCM may be a limitation for fibrosis assessment through late gadolinium enhancement (LGE), which might be overcome through quantitative T1 and extracellular volume (ECV) assessment. T1 and ECV prognostic value for arrhythmia-related events remain poorly investigated. We asked whether T1 and ECV have a prognostic value in NIDCM patients. Methods This prospective multicenter study analyzed 225 patients with NIDCM confirmed by CMR who were followed up for 2 years. CMR evaluation included LGE, native T1 mapping and ECV values. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE) which was divided in two groups: HF-related events and arrhythmia-related events. Optimal cutoffs for prediction of MACE occurrence were calculated for all CMR quantitative values. Results Fifty-eight patients (26%) developed a MACE during follow-up, 42 patients (19%) with HF-related events and 16 patients (7%) arrhythmia-related events. T1 Z-score (p = 0.008) and global ECV (p = 0.001) were associated with HF-related events occurrence, in addition to left ventricular ejection fraction (p < 0.001). ECV > 32.1% (optimal cutoff) remained the only CMR independent predictor of HF-related events occurrence (HR 2.15 [1.14–4.07], p = 0.018). In the arrhythmia-related events group, patients had increased native T1 Z-score and ECV values, with both T1 Z-score > 4.2 and ECV > 30.5% (optimal cutoffs) being independent predictors of arrhythmia-related events occurrence (respectively, HR 2.86 [1.06–7.68], p = 0.037 and HR 2.72 [1.01–7.36], p = 0.049). Conclusions ECV was the sole independent predictive factor for both HF- and arrhythmia-related events in NIDCM patients. Native T1 was also an independent predictor in arrhythmia-related events occurrence. The addition of ECV and more importantly native T1 in the decision-making algorithm may improve arrhythmia risk stratification in NIDCM patients. Trial registration NCT02352129. Registered 2nd February 2015—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02352129

Regional changes in cellular and molecular pathology in children with end-stage dilated cardiomyopathy: Correlation with regional and global cardiac performance

“…The present study adds to our understanding of paediatric DCM phenotypes by identifying a subtype with diffuse RV fibrosis without profound dysfunction. These results should stimulate research into the pathological and prognostic significance of RV and LV fibrosis in paediatric DCM, especially as non- invasive assessment of fibrosis by magnetic resonance imaging is used in clinical prognostication of adult DCM 26 .…”

Current Insights and Novel Cardiovascular Magnetic Resonance-Based Techniques in the Prognosis of Non-Ischemic Dilated Cardiomyopathy

“…Rubiś et al documented that ECV was an independent predictor of ventricular tachycardia in DCM [42,49]. In addition to the occurrence of arrhythmia-related events, it was shown that ECV with a value > 32.1% was an independent predictor and associated with a four-fold increase in the risk of heart failure events [40]. Furthermore, ECV demonstrated a prognostic value even in patients with DCM and negative LGE [41].…”

“…Cadour et al [40] conducted a prospective longitudinal, multicenter study with a 2-year follow-up of 225 patients with a formal diagnosis of DCM. They documented that T1 mapping was an independent predictor of arrhythmia-related events in this population.…”

Efficacy of Native T₁ Mapping for Patients With Non-Ischemic Cardiomyopathy and Ventricular Functional Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair

“…T1 mapping-based extracellular volume (ECV) and native T1 mapping are predictors of HF and arrhythmic events in NICM patients. 25 In addition to patients with NICM, T1 mapping has demonstrated a good correlation with histologic findings of interstitial myocardial fibrosis in several conditions, including valvular heart disease. 26 In patients with primary MR, chronic volume overload due to MR leads to progressive LV remodeling with diffuse interstitial fibrosis and increased T1 mapping-based ECV, and increased ECV is associated with adverse outcomes.…”