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Native T1 and ECV of noninfarcted myocardium and outcome in patients with coronary artery disease

Citation

Puntmann, VO and Carr-White, G and Jabbour, A and Yu, C-Y and Gebker, R and Kelle, S and Rolf, A and Zitzmann, S and Peker, E and D'Angelo, T and Pathan, F and Elen, A and Valbuena, S and Hinojar, R and Arendt, C and Narula, J and Herrmann, E and Zeiher, AM and Nagel, E, on behalf of International T1 Multicentre CMR Outcome Study, Native T1 and ECV of noninfarcted myocardium and outcome in patients with coronary artery disease, Journal of the American College of Cardiology, 71, (7) pp. 766-778. ISSN 0735-1097 (2018) [Refereed Article]

Copyright Statement

Copyright 2018 The American College of Cardiology Foundation

DOI: doi:10.1016/j.jacc.2017.12.020

Abstract

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 [22] years; 64%; median follow-up period of 17 [11] 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.

Item Details

Item Type:Refereed Article
Keywords:T1 mapping, coronary artery disease, ischemic heart disease, outcome, remodeling
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Pathan, F (Dr Faraz Pathan)
ID Code:125744
Year Published:2018
Web of Science® Times Cited:25
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-05-03
Last Modified:2019-01-17
Downloads:0

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