European Radiology

, Volume 27, Issue 9, pp 3924–3933 | Cite as

Contrast-enhanced T1 mapping-based extracellular volume fraction independently predicts clinical outcome in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study

  • Jong-Chan Youn
  • Yoo Jin HongEmail author
  • Hye-Jeong Lee
  • Kyunghwa Han
  • Chi Young Shim
  • Geu-Ru Hong
  • Young Joo Suh
  • Jin Hur
  • Young Jin Kim
  • Byoung Wook Choi
  • Seok-Min Kang



We aimed to evaluate the prognostic role of cardiac magnetic resonance imaging (CMR)–based extracellular volume fraction (ECV) in patients with non-ischemic dilated cardiomyopathy (NIDCM) and compare it with late gadolinium enhancement (LGE) parameters.


This was a single-center, prospective, cohort study of 117 NIDCM patients (71 men, 51.9 ± 16.7 years) who underwent clinical 3.0-T CMR. Myocardial ECV and LGE were quantified on the left ventricular myocardium. The presence of midwall LGE was also detected. Nineteen healthy subjects served as controls. The primary end points were cardiovascular (CV) events defined by CV death, rehospitalization due to heart failure, and heart transplantation.


During the follow-up period (median duration, 11.2 months; 25th–75th percentile, 7.8–21.9 months), the primary end points occurred in 19 patients (16.2%). The ECV (per 3% and 1% increase) was associated with a hazard ratio of 1.80 and 1.22 (95% confidence interval [CI], 1.48–2.20 and 1.14–1.30, respectively; p < 0.001) for the CV events. Multivariable analysis also indicated that ECV was an independent prognostic factor and had a higher prognostic value (Harrell’s c statistic, 0.88) than LGE quantification values (0.77) or midwall LGE (0.80).


CMR-based ECV independently predicts the clinical outcome in NIDCM patients.

Key Points

T1-mappingbased ECV is a useful parameter of risk stratification in NIDCM

ECV has a higher prognostic value than LGE

Contrast-enhanced T1-mapping CMR is a feasible and safe method


Extracellular space Magnetic resonance imaging Prognosis Myocardium T1 mapping 



body mass index


body surface area


confidence interval


cardiac magnetic resonance imaging


cardiopulmonary exercise test




extracellular volume fraction


end-diastolic volume


ejection fraction


end-systolic volume




hazard ratio


intra-class correlation coefficient


late gadolinium enhancement


left ventricle


non-ischemic dilated cardiomyopathy


region of interest


right ventricle


standard deviation


stroke volume


variance inflation factor


Compliance with ethical standards


The scientific guarantor of this publication is Yoo Jin Hong.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


This study has received funding by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT & Future Planning (NRF-2015R1C1A1A02036645). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.

Statistics and biometry

Kyunghwa Han kindly provided statistical advice for this manuscript.

One of the authors - Kyunghwa Han (PhD, a statistician) has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• prognostic study

• performed at one institution

Supplementary material

330_2017_4817_MOESM1_ESM.docx (26 kb)
ESM 1 (DOCX 26 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Jong-Chan Youn
    • 1
    • 2
  • Yoo Jin Hong
    • 3
    Email author
  • Hye-Jeong Lee
    • 3
  • Kyunghwa Han
    • 3
  • Chi Young Shim
    • 2
  • Geu-Ru Hong
    • 2
  • Young Joo Suh
    • 3
  • Jin Hur
    • 3
  • Young Jin Kim
    • 3
  • Byoung Wook Choi
    • 3
  • Seok-Min Kang
    • 2
  1. 1.Division of Cardiology, Dongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
  2. 2.Division of Cardiology, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiology, Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea

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