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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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.
• T1-mapping–based 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
KeywordsExtracellular space Magnetic resonance imaging Prognosis Myocardium T1 mapping
body mass index
body surface area
cardiac magnetic resonance imaging
cardiopulmonary exercise test
extracellular volume fraction
intra-class correlation coefficient
late gadolinium enhancement
non-ischemic dilated cardiomyopathy
region of interest
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.
Institutional Review Board approval was obtained.
Written informed consent was obtained from all subjects (patients) in this study.
• prognostic study
• performed at one institution
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