The comparison of short-term prognostic value of T1 mapping with feature tracking by cardiovascular magnetic resonance in patients with severe dilated cardiomyopathy
To evaluate and compare the prognostic value of T1 mapping with feature tracking cardiovascular magnetic resonance (FT-CMR) imaging in patients with severe dilated cardiomyopathy (DCM) during short-term follow-up. A total of 46 patients with severe DCM (LVEF < 35%) underwent 3.0-T CMR with T1 mapping and FT-CMR analysis. The study end-point was defined as a combination of cardiac death, heart transplantation, and hospitalization due to cardiovascular events. The significance of the risk factors was mainly evaluated by univariate and multivariate Cox model analyses. During the median follow-up of 13 months (interquartile range 7–17 months), two patients died of heart failure, one received a heart transplantation, and six were hospitalized for heart failure. In the univariate analysis, extracellular volume fraction (ECV) showed significant predictive association with cardiovascular events (hazard ratio [HR] 1.35; 95% confidence interval [CI] 1.13–1.62; P = 0.001). No strain parameters in FT-CMR differed significantly between patients with or without events (all P > 0.05). In the multivariate analyses, ECV was the sole independent predictor of cardiovascular events (HR, 1.48; 95% CI 1.13–1.94; P = 0.005). The area under the curve of the time-dependent receiver operating characteristic in leave-one-out cross-validation (all > 0.70) further confirmed the predictive significance of ECV. In patients with severe DCM, ECV was not only a strong independent predictor of adverse cardiovascular events but also provided prognostic value prior to strain parameters of the FT-CMR in the short term.
KeywordsCardiovascular magnetic resonance Short-term prognostic values T1 mapping Feature tracking Severe dilated cardiomyopathy
Cardiovascular magnetic resonance
Left ventricular ejection fraction
Left ventricular end-diastolic volume index
Late gadolinium enhancement
Extracellular volume fraction
Feature tracking cardiovascular magnetic resonance
Speckle tracking echocardiography
Global longitudinal strain
Global circumferential strain
Region of interest
Receiver operating characteristic
Area under the curve
The study received funding from the National Natural Science Foundation of China (No. 81771799), Guangdong Provincial Science and Technology Planning Project (No. 2014A020212676), and Science and Technology Program of Guangzhou, China (No. 201707010306).
RC drafted the manuscript; JW, JX and WW acquired the data; YHJ, CWSC, HF, LL, JM, SW, CL revised the manuscript; RC, ZD, YZ and ZY provided the analysis method. HL provided the conception and design of the study.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
- 3.McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847. https://doi.org/10.1093/eurjhf/hfs105 CrossRefGoogle Scholar
- 8.Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of cardiovascular imaging. Eur Heart J 17:1321–1360. https://doi.org/10.1093/ehjci/jew082 Google Scholar
- 9.Buss SJ, Breuninger K, Lehrke S, Voss A, Galuschky C, Lossnitzer D et al (2015) Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy. Eur Heart J 16:307–315. https://doi.org/10.1093/ehjci/jeu181 Google Scholar
- 10.Park SM, Kim YH, Ahn CM, Hong SJ, Lim DS, Shim WJ (2011) Relationship between ultrasonic tissue characterization and myocardial deformation for prediction of left ventricular reverse remodelling in non-ischaemic dilated cardiomyopathy. Eur J Echocardiogr 12:887–894. https://doi.org/10.1093/ejechocard/jer177 CrossRefGoogle Scholar
- 11.Moon JCMD, Kellman P, Piechnik SK, Robson MD, Ugander M, Gatehouse PD, Arai AE, Friedrich MG, Neubauer S, Schulz-Menger J, Schelbert EB (2013) Myocardial T1 mapping and extracellular volume quantification: a society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 15:92. https://doi.org/10.1186/1532-429X-15-92 CrossRefGoogle Scholar
- 12.aus dem Siepen F, Buss SJ, Messroghli D, Andre F, Lossnitzer D, Seitz S, Keller M et al (2014) T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy. Eur Heart J 16:210–216. https://doi.org/10.1093/ehjci/jeu183 Google Scholar
- 18.Miller CA, Naish JH, Bishop P, Coutts G, Clark D, Zhao S et al (2013) Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 6:373–383. https://doi.org/10.1161/CIRCIMAGING.112.000192 CrossRefGoogle Scholar
- 19.Hong YJ, Park CH, Kim YJ, Hur J, Lee H-J, Hong SR et al (2015) Extracellular volume fraction in dilated cardiomyopathy patients without obvious late gadolinium enhancement: comparison with healthy control subjects. Int J Cardiovasc Imaging 31:115–122. https://doi.org/10.1007/s10554-015-0595-0 CrossRefGoogle Scholar
- 20.Kawel NNM, Zavodni A, Jones J, Liu S, Sibley CT, Bluemke DA (2012) T1 mapping of the myocardium: intra-individual assessment of the effect of field strength, cardiac cycle and variation by myocardial region. J Cardiovasc Magn Reson Imaging 14:27. https://doi.org/10.1186/1532-429X-14-27 CrossRefGoogle Scholar
- 21.Aleksova A, Sabbadini G, Merlo M, Pinamonti B, Barbati G, Zecchin M et al (2009) Natural history of dilated cardiomyopathy: from asymptomatic left ventricular dysfunction to heart failure—a subgroup analysis from the Trieste Cardiomyopathy Registry. J Cardiovasc Med 10:699–705. https://doi.org/10.2459/JCM.0b013e32832bba35 CrossRefGoogle Scholar
- 22.Arenja NRJ, Fritz T, Andre F, Siepen F, Mueller-Hennessen MGE, Katus HA, Friedrich MG, Buss SJ (2017) Diagnostic and prognostic value of long-axis strain and myocardial contraction fraction using standard cardiovascular MR imaging in patients with nonischemic dilated cardiomyopathies. Radiology 283:681–691. https://doi.org/10.1148/radiol.2016161184 CrossRefGoogle Scholar