Author + information
- Received August 1, 2017
- Revision received December 7, 2017
- Accepted December 7, 2017
- Published online February 12, 2018.
- Valentina O. Puntmann, MD, PhDa,b,c,∗ (, )
- Gerry Carr-White, MBBS, PhDb,d,
- Andrew Jabbour, MBBS, PhDe,
- Chung-Yao Yu, MBBSe,
- Rolf Gebker, MDf,
- Sebastian Kelle, MDf,
- Andreas Rolf, MDg,
- Sabine Zitzmann, MDg,
- Elif Peker, MDa,h,
- Tommaso D’Angelo, MDa,i,
- Faraz Pathan, MDa,j,
- Elen, MDa,k,
- Silvia Valbuena, MDa,l,
- Rocio Hinojar, MD, Mresa,m,
- Christophe Arendt, MDa,n,
- Jagat Narula, MD, PhDo,
- Eva Herrmann, PhDp,
- Andreas M. Zeiher, MDc,
- Eike Nagel, MD, PhDa,b,c,n,
- on behalf of International T1 Multicentre CMR Outcome Study
- aInstitute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
- bDepartment of Cardiovascular Services, Guy's and St. Thomas’ NHS Trust, London, United Kingdom
- cDepartment of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
- dKing’s College Hospital NHS Trust, Denmark Hill, London, United Kingdom
- eDepartment of Cardiology, St. Vincent’s University, Sydney, New South Wales, Australia
- fDepartment of Cardiology, German Heart Institute Berlin, Berlin, Germany
- gDepartment of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
- hDepartment of Radiology, Ankara University Hospital, Ankara, Turkey
- iDepartment of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy
- jDepartment of Cardiovascular Imaging, Menzies Institute for Medical Research, Hobart Tasmania, Australia
- kDepartment of Cardiology, University Hospital Jakarta, Jakarta, Indonesia
- lDepartment of Cardiology, University Hospital La Paz, Madrid, Spain
- mDepartment of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
- nDepartment of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
- oDepartment of Cardiology, Mount Sinai School of Medicine, New York, New York
- pDZHK Institute of Biostatistics and Mathematical Modelling at Goethe University Frankfurt, Frankfurt am Main, Germany
- ↵∗Address for correspondence:
Dr. Valentina O. Puntmann, Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Theodor-Stern Kai 7, Goethe University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
Background Coronary artery disease (CAD) remains the major cause of cardiac morbidity and mortality worldwide, despite the advances in treatment with coronary revascularization and modern antiremodeling therapy. Risk stratification in CAD patients is primarily based on left ventricular volumes, ejection fraction (LVEF), risk scores, and the presence and extent of late gadolinium enhancement (LGE). The prognostic role of T1 mapping in noninfarcted myocardium in CAD patients has not yet been determined.
Objectives This study sought to examine prognostic significance of native T1 mapping of noninfarcted myocardium in patients with CAD.
Methods A prospective, observational, multicenter longitudinal study of consecutive patients undergoing routine cardiac magnetic resonance imaging with T1 mapping and LGE. The primary endpoint was all-cause mortality. Major adverse cardiocerebrovascular events (MACCE) (cardiac mortality, nonfatal acute coronary syndrome, stroke, and appropriate device discharge) are also reported.
Results A total of 34 deaths and 71 MACCE (n = 665, males n = 424, median age [interquartile range] 57  years; 64%; median follow-up period of 17  months) were observed. Native T1 and extracellular volume were univariate predictors of outcome. Native T1 and LGE were stronger predictors of survival and MACCE compared with extracellular volume, LVEF, cardiac volumes, and clinical scores (p < 0.001). Native T1 of noninfarcted myocardium was the sole independent predictor of all-cause mortality (chi-square = 21.7; p < 0.001), which was accentuated in the absence of LGE or LVEF ≤35%. For MACCE, native T1 and LGE extent were joint independent predictors (chi-square = 25.6; p < 0.001).
Conclusions Characterization of noninfarcted myocardium by native T1 is an important predictor of outcome in CAD patients, over and above the traditional risk stratifiers. The current study’s results provide a basis for a novel risk stratification model in CAD based on a complementary assessment of noninfarcted myocardium and post-infarction scar, by native T1 mapping and LGE, respectively.
Funded by the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre (BRC) award to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. Dr. Hinojar was supported by a Spanish Cardiology Society fellowship; Drs. Jabbour and Yu by the Victor Chang Cardiac Research Institute; and Drs. Puntmann, Herrmann, Zeiher, and Nagel by the German Ministry of Education and Research via the German Centre for Cardiovascular Research (DZHK). Dr. Nagel has been a consultant for and received grant support and speaker honoraria from Bayer AG. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Christopher M. Kramer, MD, served as Guest Editor for this paper.
- Received August 1, 2017.
- Revision received December 7, 2017.
- Accepted December 7, 2017.
- 2018 American College of Cardiology Foundation
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