Author + information
- Received August 12, 2019
- Revision received January 22, 2020
- Accepted January 30, 2020
- Published online July 6, 2020.
- Kongkiat Chaikriangkrai, MDa,∗∗ (, )@SoonKongkiat,
- Muhannad Aboud Abbasi, MDa,∗,
- Roberto Sarnari, MDa,
- Ryan Dolan, MDa,
- Daniel Lee, MDb,
- Allen S. Anderson, MDb,
- Kambiz Ghafourian, MDb,
- Sadiya S. Khan, MDb,
- Esther E. Vorovich, MDb,
- Jonathan D. Rich, MDb,
- Jane E. Wilcox, MDb,
- Julie A. Blaisdell, MSa,
- Clyde W. Yancy, MDb,
- James Carr, MDa and
- Michael Markl, PhDa
- aDepartment of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- bDivision of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Kongkiat Chaikriangkrai, Department of Radiology, Northwestern University, 737 North Michigan Avenue, Suite 1600, Chicago, Illinois 60611.
Objectives The purpose of this study was to examine prognostic value of T1- and T2-mapping techniques in heart transplant patients.
Background Myocardial characterization using T2 mapping (evaluation of edema/inflammation) and pre- and post-gadolinium contrast T1 mapping (calculation of extracellular volume fraction [ECV] for assessment of interstitial expansion/fibrosis) are emerging modalities that have been investigated in various cardiomyopathies.
Methods A total of 99 heart transplant patients underwent the magnetic resonance imaging (MRI) scans including T1- (n = 90) and T2-mapping (n = 79) techniques. Relevant clinical characteristics, MRI parameters including late gadolinium enhancement (LGE), and invasive hemodynamics were collected. Median clinical follow-up duration after the baseline scan was 2.4 to 3.5 years. Clinical outcomes include cardiac events (cardiac death, myocardial infarction, coronary revascularization, and heart failure hospitalization), noncardiac death and noncardiac hospitalization.
Results Overall, the global native T1, postcontrast T1, ECV, and T2 were 1,030 ± 56 ms, 458 ± 84 ms, 27 ± 4% and 50 ± 4 ms, respectively. Top-tercile-range ECV (ECV >29%) independently predicted adverse clinical outcomes compared with bottom-tercile-range ECV (ECV <25%) (hazard ratio [HR]: 2.87; 95% confidence interval [CI]: 1.07 to 7.68; p = 0.04) in a multivariable model with left ventricular end-systolic volume and LGE. Higher T2 (T2 ≥50.2 ms) independently predicted adverse clinical outcomes (HR: 3.01; 95% CI: 1.39 to 6.54; p = 0.005) after adjustment for left ventricular ejection fraction, left ventricular end-systolic volume, and LGE. Additionally, higher T2 (T2 ≥50.2 ms) also independently predicted cardiac events (HR: 4.92; CI: 1.60 to 15.14; p = 0.005) in a multivariable model with left ventricular ejection fraction.
Conclusions MRI-derived myocardial ECV and T2 mapping in heart transplant patients were independently associated with cardiac and noncardiac outcomes. Our findings highlight the need for larger prospective studies.
- extracellular volume fraction
- heart transplantation
- magnetic resonance imaging
- natural history
- T1 mapping
- T2 mapping
↵∗ Drs. Chaikriangkrai and Abbasi contributed equally to this work.
Supported by the National Institutes of Health, National Heart, Lung, and Blood Institute grant R01 HL117888. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received August 12, 2019.
- Revision received January 22, 2020.
- Accepted January 30, 2020.
- 2020 American College of Cardiology Foundation
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