Author + information
- Received October 28, 2015
- Revision received December 1, 2015
- Accepted December 1, 2015
- Published online January 1, 2016.
- Valentina O. Puntmann, MD, PhD∗,†,‡,§∗ (, )
- Gerry Carr-White, MBBS, PhD∗,†,
- Andrew Jabbour, MBBS, PhD‖,
- Chung-Yao Yu, MBBS‖,
- Rolf Gebker, MD, PhD¶,
- Sebastian Kelle, MD, PhD¶,
- Rocio Hinojar, MD, Mres∗,#,
- Adelina Doltra, MD, PhD¶,
- Niharika Varma, MD∗,§,
- Nicholas Child, MBBS, PhD∗,§,
- Toby Rogers, MD†,§,
- Gonca Suna, MD†∗∗,
- Eduardo Arroyo Ucar, MD∗,
- Ben Goodman, MSc∗,
- Sitara Khan, MD, PhD†∗∗,
- Darius Dabir, MD∗,††,
- Eva Herrmann, PhD‡‡,
- Andreas M. Zeiher, MD, PhD‡,
- Eike Nagel, MD, PhD∗,†,‡,§,§§,
- International T1 Multicentre CMR Outcome Study
- ∗Guys and St Thomas’ NHS Trust, London, England
- †King’s College Hospital NHS Trust, London, England
- ‡Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
- §Department of Cardiac Imaging, King’s College London, London, England
- ‖St Vincent’s University, Sydney, Australia
- ¶German Heart Institute Berlin, Berlin, Germany
- #Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
- ∗∗Cardiovascular Division, King’s College London, London, England
- ††Department of Radiology, University of Bonn, Bonn, Germany
- ‡‡Institute of Biostatistics and Mathematical Modelling at Goethe University Frankfurt; Frankfurt am Main, Germany
- §§Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
- ↵∗Reprint requests and correspondence:
Dr. Valentina O. Puntmann, Department of Cardiology, Guys and St Thomas’ Hospital, Westminster Bridge Road, London, United Kingdom.
Objectives The study sought to examine prognostic relevance of T1 mapping parameters (based on a T1 mapping method) in nonischemic dilated cardiomyopathy (NIDCM) and compare them with conventional markers of adverse outcome.
Background NIDCM is a recognized cause of poor clinical outcome. NIDCM is characterized by intrinsic myocardial remodeling due to complex pathophysiological processes affecting myocardium diffusely. Lack of accurate and noninvasive characterization of diffuse myocardial disease limits recognition of early cardiomyopathy and effective clinical management in NIDCM. Cardiac magnetic resonance (CMR) supports detection of diffuse myocardial disease by T1 mapping.
Methods This is a prospective observational multicenter longitudinal study in 637 consecutive patients with dilated NIDCM (mean age 50 years [interquartile range: 37 to 76 years]; 395 males [62%]) undergoing CMR with T1 mapping and late gadolinium enhancement (LGE) at 1.5-T and 3.0-T. The primary endpoint was all-cause mortality. A composite of heart failure (HF) mortality and hospitalization was a secondary endpoint.
Results During a median follow-up period of 22 months (interquartile range: 19 to 25 months), we observed a total of 28 deaths (22 cardiac) and 68 composite HF events. T1 mapping indices (native T1 and extracellular volume fraction), as well as the presence and extent of LGE, were predictive of all-cause mortality and HF endpoint (p < 0.001 for all). In multivariable analyses, native T1 was the sole independent predictor of all-cause and HF composite endpoints (hazard ratio: 1.1; 95% confidence interval: 1.06 to 1.15; hazard ratio: 1.1; 95% confidence interval: 1.05 to 1.1; p < 0.001 for both), followed by the models including the extent of LGE and right ventricular ejection fraction, respectively.
Conclusions Noninvasive measures of diffuse myocardial disease by T1 mapping are significantly predictive of all-cause mortality and HF events in NIDCM. We provide a basis for a novel algorithm of risk stratification in NIDCM using a complementary assessment of diffuse and regional disease by T1 mapping and LGE, respectively.
Funding was received from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre (BRC) award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. Drs. Puntmann, Hermann, Zeiher, and Nagel have received funding from the German Ministry of Education and Research via the German Centre for Cardiovascular Research (DZHK). Drs. Puntmann and Nagel hold a patent of invention for a method for differentiation of normal myocardium from diffuse disease using T1 mapping in nonischemic cardiomyopathies and others (based on PR-MS 33.297, PR-MS 33.837, PR-MS 33.654; with no financial interest). Drs. Jabbour and Yu were funded by the Victor Chang Cardiac Research Institute. Dr. Hinojar was funded by a Spanish Cardiology Society fellowship. Dr. Child has received funding from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Javier Sanz, MD, served as Guest Editor for this paper.
- Received October 28, 2015.
- Revision received December 1, 2015.
- Accepted December 1, 2015.
- American College of Cardiology Foundation