Author + information
- Received August 19, 2015
- Revision received October 30, 2015
- Accepted November 3, 2015
- Published online January 1, 2016.
- Andreas A. Kammerlander, MD∗,
- Beatrice A. Marzluf, MD, MSc∗,
- Caroline Zotter-Tufaro, MSc∗,
- Stefan Aschauer, MD∗,
- Franz Duca, MD∗,
- Alina Bachmann, MD∗,
- Klaus Knechtelsdorfer∗,
- Matthias Wiesinger∗,
- Stefan Pfaffenberger, MD∗,
- Andreas Greiser, PhD†,
- Irene M. Lang, MD∗,
- Diana Bonderman, MD∗ and
- Julia Mascherbauer, MD∗∗ ()
- ∗Division of Cardiology, Medical University of Vienna, Vienna, Austria
- †Siemens Healthcare GmbH, Erlangen, Germany
- ↵∗Reprint requests and correspondence:
Dr. Julia Mascherbauer, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Objectives The purpose of this study was to prospectively investigate the diagnostic and prognostic impact of cardiac magnetic resonance (CMR) T1 mapping and validate it against left ventricular biopsies.
Background Extracellular volume (ECV) expansion is a key feature of heart failure. CMR T1 mapping has been developed as a noninvasive technique to estimate ECV; however, the diagnostic and prognostic impacts of this technique have not been well established.
Methods A total of 473 consecutive patients referred for CMR (49.5% female, age 57.8 ± 17.1 years) without hypertrophic cardiomyopathy, cardiac amyloidosis, or Anderson-Fabry disease were studied. T1 mapping with the modified Look-Locker inversion recovery (MOLLI) sequence was used for ECV calculation (CMR-ECV). For methodological validation, 36 patients also underwent left ventricular biopsy, and ECV was quantified by TissueFAXS analysis (TissueFAXS-ECV). To assess the prognostic value of CMR-ECV, its association with hospitalization for cardiovascular reasons or cardiac death was tested in a multivariable Cox regression model.
Results TissueFAXS-ECV was 26.3 ± 7.2% and was significantly correlated with CMR-ECV (r = 0.493, p = 0.002). Patients were followed up for 13.3 ± 9.0 months and divided into CMR-ECV tertiles for Kaplan-Meier analysis (tertiles were ≤25.7%, 25.8% to 28.5%, and ≥28.6%). Significantly higher event rates were observed in patients with higher CMR-ECV (log-rank p = 0.013). By multivariable Cox regression analysis, CMR-ECV was independently associated with outcome among imaging variables (p = 0.004) but not after adjustment for clinical parameters.
Conclusions CMR T1 mapping allows accurate noninvasive quantification of ECV and is independently associated with event-free survival among imaging parameters. Its prognostic value on top of established clinical risk factors warrants further investigation in long-term studies.
This study received support from the Austrian Society of Cardiology (Dr. Mascherbauer), the Österreichischer Herzfonds (Dr. Mascherbauer) and the Austrian fellowship grant KLI 245 (to Dr. Mascherbauer) and KLI 246 (Dr. Bonderman). Siemens Healthcare GmbH (Erlangen, Germany) provided the T1-mapping prototype as a work-in-progress package but had no influence on study design, data processing, or statistical analysis. Dr. Greiser is an employee of Siemens Healthcare GmbH. Dr. Lang has received grants and speakers’ fees from Actelion Pharmaceuticals, Bayer, United Therapeutics, and AOP Orphan Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 19, 2015.
- Revision received October 30, 2015.
- Accepted November 3, 2015.
- American College of Cardiology Foundation