Noncontrast Myocardial T1 Mapping by Cardiac Magnetic Resonance Predicts Outcome in Patients With Aortic Stenosis

The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS). Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadoliniu...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2018-07, Vol.11 (7), p.974-983
Main Authors: Lee, Heesun, Park, Jun-Bean, Yoon, Yeonyee E., Park, Eun-Ah, Kim, Hyung-Kwan, Lee, Whal, Kim, Yong-Jin, Cho, Goo-Yeong, Sohn, Dae-Won, Greiser, Andreas, Lee, Seung-Pyo
Format: Article
Language:English
Subjects:
Aged
aortic stenosis
Aortic Valve Stenosis - complications
Aortic Valve Stenosis - diagnostic imaging
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - therapy
cardiac magnetic resonance
Case-Control Studies
Cause of Death
Female
Fibrosis
Heart Failure - etiology
Heart Failure - mortality
Heart Failure - therapy
Hospitalization
Humans
Longitudinal Studies
Magnetic Resonance Imaging
Male
Middle Aged
Myocardium - pathology
native T1 mapping
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors
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Summary:The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS). Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown. A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68.8 ± 9.2 years of age, 49.6% male) and 33 age- and sex-matched controls who underwent 3-T CMR. The degree of diffuse myocardial fibrosis was assessed by noncontrast mapping of T1 relaxation time using modified Look-Locker inversion-recovery sequence, and the presence and extent of LGE were also evaluated. The AS patients were divided into 3 groups by the native T1 value. Primary endpoint was a composite of all-cause death and hospitalization for heart failure. Native T1 value was higher in AS patients, compared with control subjects (1,232 ± 53 ms vs. 1,185 ± 37 ms; p = 0.008). During follow-up (median 27.9 months), there were 24 clinical events including 9 deaths (6 pre-operative and 3 post-operative), the majority of which occurred in the patients in the highest T1 tertile group (2.4% vs. 11.6% vs. 42.9% for lowest, mid-, and highest tertile groups; p < 0.001 by log-rank test). The total number of events for both pre- and post-operative events also occurred more frequently in patients in the highest T1 tertile group. EuroSCORE II, the presence and/or extent of LGE, and the native T1 value were predictors of poor prognosis (adjusted hazard ratio for every 20-ms increase of native T1: 1.28; p = 0.003). In particular, the highest native T1 value provided further risk stratification regardless of the presence of LGE. High native T1 value on noncontrast T1 mapping CMR is a novel, independent predictor of adverse outcome in patients with significant AS. [Display omitted]
ISSN:1936-878X
1876-7591
DOI:10.1016/j.jcmg.2017.09.005