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

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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

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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

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Author information

Correspondence to Yoo Jin Hong.

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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

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Cite this article

Youn, J., Hong, Y.J., Lee, H. et al. Contrast-enhanced T1 mapping-based extracellular volume fraction independently predicts clinical outcome in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study. Eur Radiol 27, 3924–3933 (2017). https://doi.org/10.1007/s00330-017-4817-9

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Keywords

  • Extracellular space
  • Magnetic resonance imaging
  • Prognosis
  • Myocardium
  • T1 mapping