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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
Cardiac

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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

Keywords

Extracellular space Magnetic resonance imaging Prognosis Myocardium T1 mapping 

Abbreviations

BMI

body mass index

BSA

body surface area

CI

confidence interval

CMR

cardiac magnetic resonance imaging

CPET

cardiopulmonary exercise test

CV

cardiovascular

ECV

extracellular volume fraction

EDV

end-diastolic volume

EF

ejection fraction

ESV

end-systolic volume

Hct

hematocrit

HR

hazard ratio

ICC

intra-class correlation coefficient

LGE

late gadolinium enhancement

LV

left ventricle

NIDCM

non-ischemic dilated cardiomyopathy

ROI

region of interest

RV

right ventricle

SD

standard deviation

SV

stroke volume

VIF

variance inflation factor

Notes

Compliance with ethical standards

Guarantor

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.

Funding

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.

Methodology

• 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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