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Noncontrast Myocardial T1 Mapping by Cardiac Magnetic Resonance Predicts Outcome in Patients With Aortic Stenosis.
JACC: Cardiovascular Imaging ( IF 14.0 ) Pub Date : 2017-11-15 , DOI: 10.1016/j.jcmg.2017.09.005
Heesun Lee 1 , Jun-Bean Park 2 , Yeonyee E Yoon 3 , Eun-Ah Park 4 , Hyung-Kwan Kim 2 , Whal Lee 4 , Yong-Jin Kim 2 , Goo-Yeong Cho 3 , Dae-Won Sohn 2 , Andreas Greiser 5 , Seung-Pyo Lee 2
Affiliation  

OBJECTIVES The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS). BACKGROUND Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown. METHODS A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68.8 ± 9.2 years of age, 49.6% male) and 33 age- and sex-matched controls who underwent 3-T CMR. The degree of diffuse myocardial fibrosis was assessed by noncontrast mapping of T1 relaxation time using modified Look-Locker inversion-recovery sequence, and the presence and extent of LGE were also evaluated. The AS patients were divided into 3 groups by the native T1 value. Primary endpoint was a composite of all-cause death and hospitalization for heart failure. RESULTS Native T1 value was higher in AS patients, compared with control subjects (1,232 ± 53 ms vs. 1,185 ± 37 ms; p = 0.008). During follow-up (median 27.9 months), there were 24 clinical events including 9 deaths (6 pre-operative and 3 post-operative), the majority of which occurred in the patients in the highest T1 tertile group (2.4% vs. 11.6% vs. 42.9% for lowest, mid-, and highest tertile groups; p < 0.001 by log-rank test). The total number of events for both pre- and post-operative events also occurred more frequently in patients in the highest T1 tertile group. EuroSCORE II, the presence and/or extent of LGE, and the native T1 value were predictors of poor prognosis (adjusted hazard ratio for every 20-ms increase of native T1: 1.28; p = 0.003). In particular, the highest native T1 value provided further risk stratification regardless of the presence of LGE. CONCLUSIONS High native T1 value on noncontrast T1 mapping CMR is a novel, independent predictor of adverse outcome in patients with significant AS.

中文翻译:

通过心脏磁共振的非对比心肌T1映射可预测主动脉瓣狭窄患者的预后。

目的本研究的目的是评估心肌的心脏磁共振(CMR)的天然T1值是否可以预测患有严重主动脉瓣狭窄(AS)的患者的临床事件。背景技术尽管先前的研究已经证明了通过CMR晚期late增强(LGE)对AS患者进行局灶性纤维化的预后价值,但通过无创成像对弥漫性心肌纤维化的预后意义仍然未知。方法对127例中度或重度AS患者(68.8±9.2岁,男性49.6%)和33例年龄和性别相匹配的3-T CMR患者进行了一项前瞻性观察性纵向研究。使用改良的Look-Locker反转恢复序列,通过T1弛豫时间的非对比图谱评估弥漫性心肌纤维化程度,并评估了LGE的存在和程度。AS患者按原始T1值分为3组。主要终点指标是全因死亡和心力衰竭住院的综合结果。结果与对照组相比,AS患者的天然T1值更高(1,232±53 ms vs. 1,185±37 ms; p = 0.008)。在随访期间(中位27.9个月),发生了24例临床事件,包括9例死亡(术前6例,术后3例),其中大多数发生在最高T1三分位组的患者中(2.4%比11.6) %,最低,中等和最高三分位数组为42.9%;对数秩检验,p <0.001)。T1三分位数最高的组的患者术前和术后事件的总数也更频繁地发生。EuroSCORE II,LGE的存在和/或范围,T1值和天然T1值是预后不良的预测指标(天然T1每增加20ms调整的危险比:1.28; p = 0.003)。特别是,无论是否存在LGE,最高的天然T1值都会提供进一步的风险分层。结论非对比T1映射CMR的天然T1值高是严重AS患者不良结局的一种新的,独立的预测因子。
更新日期:2018-07-02
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