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T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2016 Jan; Vol. 9 (1), pp. 40-50. - Publication Year :
- 2016
-
Abstract
- Objectives: The study sought to examine prognostic relevance of T1 mapping parameters (based on a T1 mapping method) in nonischemic dilated cardiomyopathy (NIDCM) and compare them with conventional markers of adverse outcome.<br />Background: NIDCM is a recognized cause of poor clinical outcome. NIDCM is characterized by intrinsic myocardial remodeling due to complex pathophysiological processes affecting myocardium diffusely. Lack of accurate and noninvasive characterization of diffuse myocardial disease limits recognition of early cardiomyopathy and effective clinical management in NIDCM. Cardiac magnetic resonance (CMR) supports detection of diffuse myocardial disease by T1 mapping.<br />Methods: This is a prospective observational multicenter longitudinal study in 637 consecutive patients with dilated NIDCM (mean age 50 years [interquartile range: 37 to 76 years]; 395 males [62%]) undergoing CMR with T1 mapping and late gadolinium enhancement (LGE) at 1.5-T and 3.0-T. The primary endpoint was all-cause mortality. A composite of heart failure (HF) mortality and hospitalization was a secondary endpoint.<br />Results: During a median follow-up period of 22 months (interquartile range: 19 to 25 months), we observed a total of 28 deaths (22 cardiac) and 68 composite HF events. T1 mapping indices (native T1 and extracellular volume fraction), as well as the presence and extent of LGE, were predictive of all-cause mortality and HF endpoint (p < 0.001 for all). In multivariable analyses, native T1 was the sole independent predictor of all-cause and HF composite endpoints (hazard ratio: 1.1; 95% confidence interval: 1.06 to 1.15; hazard ratio: 1.1; 95% confidence interval: 1.05 to 1.1; p < 0.001 for both), followed by the models including the extent of LGE and right ventricular ejection fraction, respectively.<br />Conclusions: Noninvasive measures of diffuse myocardial disease by T1 mapping are significantly predictive of all-cause mortality and HF events in NIDCM. We provide a basis for a novel algorithm of risk stratification in NIDCM using a complementary assessment of diffuse and regional disease by T1 mapping and LGE, respectively.<br /> (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Cardiomyopathy, Dilated complications
Cardiomyopathy, Dilated mortality
Cardiomyopathy, Dilated pathology
Cardiomyopathy, Dilated physiopathology
Cause of Death
Disease Progression
Europe
Female
Heart Failure diagnosis
Heart Failure mortality
Heart Failure physiopathology
Hospitalization
Humans
Kaplan-Meier Estimate
Longitudinal Studies
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Factors
Stroke Volume
Time Factors
Ventricular Function, Left
Ventricular Function, Right
Cardiomyopathy, Dilated diagnosis
Heart Failure etiology
Magnetic Resonance Imaging
Myocardium pathology
Ventricular Remodeling
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 9
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 26762873
- Full Text :
- https://doi.org/10.1016/j.jcmg.2015.12.001