Author + information
- Received April 17, 2017
- Revision received September 6, 2017
- Accepted September 14, 2017
- Published online July 2, 2018.
- Heesun Lee, MDa,b,
- Jun-Bean Park, MD, PhDa,c,
- Yeonyee E. Yoon, MDa,d,
- Eun-Ah Park, MD, PhDe,
- Hyung-Kwan Kim, MD, PhDa,c,
- Whal Lee, MD, PhDe,
- Yong-Jin Kim, MD, PhDa,c,
- Goo-Yeong Cho, MD, PhDa,d,
- Dae-Won Sohn, MD, PhDa,c,
- Andreas Greiser, PhDf and
- Seung-Pyo Lee, MD, PhDa,c,∗ ()
- aDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- bHealthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
- cCardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- dDepartment of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- eDepartment of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- fSiemens Healthcare, Erlangen, Germany
- ↵∗Address for correspondence:
Dr. Seung-Pyo Lee, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Republic of Korea.
Objectives The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS).
Background Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown.
Methods A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68.8 ± 9.2 years of age, 49.6% male) and 33 age- and sex-matched controls who underwent 3-T CMR. The degree of diffuse myocardial fibrosis was assessed by noncontrast mapping of T1 relaxation time using modified Look-Locker inversion-recovery sequence, and the presence and extent of LGE were also evaluated. The AS patients were divided into 3 groups by the native T1 value. Primary endpoint was a composite of all-cause death and hospitalization for heart failure.
Results Native T1 value was higher in AS patients, compared with control subjects (1,232 ± 53 ms vs. 1,185 ± 37 ms; p = 0.008). During follow-up (median 27.9 months), there were 24 clinical events including 9 deaths (6 pre-operative and 3 post-operative), the majority of which occurred in the patients in the highest T1 tertile group (2.4% vs. 11.6% vs. 42.9% for lowest, mid-, and highest tertile groups; p < 0.001 by log-rank test). The total number of events for both pre- and post-operative events also occurred more frequently in patients in the highest T1 tertile group. EuroSCORE II, the presence and/or extent of LGE, and the native T1 value were predictors of poor prognosis (adjusted hazard ratio for every 20-ms increase of native T1: 1.28; p = 0.003). In particular, the highest native T1 value provided further risk stratification regardless of the presence of LGE.
Conclusions High native T1 value on noncontrast T1 mapping CMR is a novel, independent predictor of adverse outcome in patients with significant AS.
This study was supported by grants from the Korean Health Technology R&D Project (HI15C0399), Ministry of Health, Welfare & Family Affairs, and the Basic Science Research Program through the National Research Foundation of Korea (2014R1A1A1003004), Ministry of Education, South Korea. Other than financial support, the funders were not involved in protocol development or the study process, including implementation, management, data collection, or data analysis. Dr. Greiser is an employee of Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 17, 2017.
- Revision received September 6, 2017.
- Accepted September 14, 2017.
- 2018 American College of Cardiology Foundation