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Native T1 heterogeneity for predicting reverse remodeling in patients with non-ischemic dilated cardiomyopathy

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Abstract

A recent study has shown that the heterogeneity of native T1 mapping may be a new prognostic factor for patients with non-ischemic dilated cardiomyopathy (NIDCM). This study aimed to investigate the predictive value of native T1 heterogeneity of the left ventricular (LV) myocardium, as assessed by pixel-wise histogram analysis, for predicting left ventricular reverse remodeling (LVRR) by medical therapy in patients with NIDCM. A total of one hundred and thirteen NIDCM patients (mean age: 63 ± 12 years; 91 males and 22 females; mean LV ejection fraction (EF): 37 ± 10%) were retrospectively analyzed. T1 mapping images were acquired using a modified look-locker inversion recovery (MOLLI) sequence. We performed histogram analysis of native T1 mapping of LV myocardium, mean (T1-mean) and standard deviation (T1-STD) of native T1 time from each pixel were calculated. Extracellular volume fraction (ECV) was also evaluated. LVRR was defined as LVEF increased ≥ 10% points and decrease in LV end-diastolic volume ≥ 10% at 12 months from initiation of medical therapy. Cutoff value of T1-mean and T1-STD was set as median value of each parameter. Sixty (53%) NIDCM patients reached LVRR. Area under the receiver-operating characteristics curve for predicting LVRR was 0.763 (95% confidence interval (CI) 0.679–0.847) for %LGE, 0.757 (95% CI 0.663–0.850) for T1-mean, 0.724 (95% CI 0.625–0.823) for T1-STD, 0.800 (95% CI 0.717–0.882) for ECV, respectively. Proportion of LVRR was significantly lower in NIDCM patients with high T1-mean and high T1-STD (12%) compared to NIDCM with high T1-mean and low T1-STD (65%) (p < 0.001). Adding T1-STD to T1-mean improved AUC from 0.757 to 0.806, comparable to AUC of ECV. Combination of T1-mean and T1-STD, a parameter of heterogeneity of native T1 of the LV myocardium, may be a useful for prediction of LVRR by medical therapy without use of gadolinium contrast for patients with NIDCM.

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Abbreviations

CMR:

Cardiac magnetic resonance

ECV:

Extracellular volume fraction

GDMT:

Guideline-directed medical therapy

IQR:

Interquartile range

NIDCM:

Non-ischemic dilated cardiomyopathy

LGE:

Late gadolinium enhancement

LVEF:

Left ventricular ejection fraction

LVEDV:

Left ventricular diastolic volume

LVRR:

Left ventricular reverse remodeling

MRI:

Magnetic resonance imaging

MOLLI:

Modified look-locker inversion recovery

ROC:

Receiver-operating characteristics

T1-mean:

Mean of native T1 time from each pixel

T1-STD:

Standard deviation of native T1 time from each pixel

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Acknowledgements

We are grateful to Masanori Ito, RT and Yuki Yoshimura, and RT for CMR image acquisition.

Funding

Research Grant, Japan Society for the Promotion of Science: Grant-in-Aid for Early-Career Scientists. WAKABA Research Grants, Yokohama Foundation for Advancement of Medical Science, Research Grants for the Development of Young Researchers.

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Author notes

  1. Minori Kinoshita and Shingo Kato equally contributed to this work.

Authors and Affiliations

  1. Department of Diagnostic Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan

    Minori Kinoshita, Shingo Kato, Naka Saito & Daisuke Utsunomiya

  2. Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan

    Sho Kodama, Mai Azuma, Naoki Nakayama & Kazuki Fukui

  3. Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan

    Tae Iwasawa

  4. Department of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan

    Kazuo Kimura

  5. Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Kanagawa, Japan

    Kouichi Tamura

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  1. Minori Kinoshita
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  2. Shingo Kato
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  3. Sho Kodama
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  4. Mai Azuma
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Correspondence to Shingo Kato.

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Kinoshita, M., Kato, S., Kodama, S. et al. Native T1 heterogeneity for predicting reverse remodeling in patients with non-ischemic dilated cardiomyopathy. Heart Vessels 37, 1541–1550 (2022). https://doi.org/10.1007/s00380-022-02057-4

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  • DOI: https://doi.org/10.1007/s00380-022-02057-4

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