4 - Prognostic Value of T1 mapping and Feature Tracking by Cardiac Magnetic Resonance in Patients with Suspected Non-Ischemic Cardiomyopathy

Saturday, February 15, 2020

1:35 PM – 1:45 PM

Location: Canary 3 & 4

Background: Impairment of systolic function is a well-known indicator of poor prognosis in patients with non-ischemic cardiomyopathy (NICM). It is, however, subject to limitations. Cardiac Magnetic Resonance (CMR) allows not only morphological and functional evaluation of Left Ventricle (LV), but also the quantification of cardiac remodeling. T1 mapping and LV strain by feature tracking are novel CMR techniques to evaluate for cardiac fibrosis and function. This study aimed to evaluate the prognostic value of CMR-assessed T1 mapping and feature tracking LV strain in patients with suspected NICM.

Methods: N=349 consecutive patients with suspected NICM underwent CMR with T1 mapping and LV strain assessment, between 2015-2018. Global circumferential strain (GCS) and global longitudinal strain (GLS), were measured using feature tracking and extracellular volume (ECV) was obtained using Modified Look-Locker Inversion Recovery. The primary endpoint was major adverse cardiac events (MACE) defined as a composite of all-cause death, heart failure hospitalization, and sustained ventricular arrhythmias.

Results: MACE occurred in 77 of 349 patients (22%) over a median follow-up of 17 months (interquartile range 22 months). Significant correlations were noted not only between GCS and LV ejection fraction (LVEF), but also between GCS and ECV (r=-0.923; p< 0.0001 & r =0.353; p< 0.0001 respectively). In the univariate analysis, significant clinical predictors of MACE included history of diabetes (hazard ratio [HR] 3.80; 95% confidence interval [CI] 1.49-9.69; p=0.005) and heart failure (HR 3.28; 95% CI 1.34-8.05; p=0.009), while significant imaging predictors included LVEF (HR 0.96; 95% CI 0.93-0.99; p=0.007), mean ECV (HR 1.10; 95% CI 1.05-1.14; p< 0.001), GCS (HR 1.14; 95% CI 1.05-1.23; p=0.001) and GLS (HR 1.17; 95% CI 1.09-1.26; p< 0.001). In the multivariate analysis, both ECV mean and GCS maintained a significant association with MACE (ECV: HR 1.06; 95% CI 1.02-1.11; p=0.008, GCS: HR 1.12; 95% CI 1.03-1.23; p=0.009). Finally, patients with both GCS ≥ -19% and ECV ≥ 30% had the highest rates of MACE in the cohort.

Conclusion: Our findings suggest that in patients with suspected NICM, the combined assessment of strain parameters and ECV by CMR, might provide complementary prognostic value, on top of conventional risk factors and LVEF.

Presenting Author(s)

AS

Ayako Seno, MD, PhD

Research Fellow
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.

Primary Author(s)

AS

Ayako Seno, MD, PhD

Research Fellow
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.

Co-Author(s)

PA

Panagiotis Antiochos

Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
Yin Ge

Cardiovascular imaging fellow
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
YC

Yi-Yun Chen

Research Associate
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
AA

Ayaz Aghayev, MD

Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
MS

Michael Steigner, MD

Director, Vascular CT/MR
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
RB

Ron Blankstein, MD

TBD
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
MJ

Michael Jerosch-Herold, PhD

Associate Professor
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
Raymond Kwong, MD

Director, Cardiac Magnetic Resonance Imaging
Harvard Medical School

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.