Objectives The purpose of this study was to examine prognostic value of T1- and T2-mapping techniques in heart transplant patients. Background Myocardial characterization using T2 mapping (evaluation of edema/inflammation) and pre- and post-gadolinium contrast T1 mapping (calculation of extracellular volume fraction [ECV] for assessment of interstitial expansion/fibrosis) are emerging modalities that have been investigated in various cardiomyopathies. Methods A total of 99 heart transplant patients underwent the magnetic resonance imaging (MRI) scans including T1- (n = 90) and T2-mapping (n = 79) techniques. Relevant clinical characteristics, MRI parameters including late gadolinium enhancement (LGE), and invasive hemodynamics were collected. Median clinical follow-up duration after the baseline scan was 2.4 to 3.5 years. Clinical outcomes include cardiac events (cardiac death, myocardial infarction, coronary revascularization, and heart failure hospitalization), noncardiac death and noncardiac hospitalization. Results Overall, the global native T1, postcontrast T1, ECV, and T2 were 1,030 ± 56 ms, 458 ± 84 ms, 27 ± 4% and 50 ± 4 ms, respectively. Top-tercile-range ECV (ECV >29%) independently predicted adverse clinical outcomes compared with bottom-tercile-range ECV (ECV <25%) (hazard ratio [HR]: 2.87; 95% confidence interval [CI]: 1.07 to 7.68; p = 0.04) in a multivariable model with left ventricular end-systolic volume and LGE. Higher T2 (T2 ≥50.2 ms) independently predicted adverse clinical outcomes (HR: 3.01; 95% CI: 1.39 to 6.54; p = 0.005) after adjustment for left ventricular ejection fraction, left ventricular end-systolic volume, and LGE. Additionally, higher T2 (T2 ≥50.2 ms) also independently predicted cardiac events (HR: 4.92; CI: 1.60 to 15.14; p = 0.005) in a multivariable model with left ventricular ejection fraction. Conclusions MRI-derived myocardial ECV and T2 mapping in heart transplant patients were independently associated with cardiac and noncardiac outcomes. Our findings highlight the need for larger prospective studies.

中文翻译：

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心肌细胞外容量分数和 T2 映射对心脏移植患者的预后价值。


目的 本研究的目的是检查 T1 和 T2 映射技术对心脏移植患者的预后价值。背景 使用 T2 标测（评估水肿/炎症）和钆对比前后 T1 标测（计算细胞外体积分数 [ECV] 以评估间质扩张/纤维化）的心肌表征是已在各种心肌病中进行研究的新兴模式。方法 共有 99 名心脏移植患者接受了磁共振成像 (MRI) 扫描，包括 T1 扫描 (n = 90) 和 T2 映射 (n = 79) 技术。收集相关临床特征、MRI 参数，包括晚期钆增强 (LGE) 和侵入性血流动力学。基线扫描后的中位临床随访时间为 2.4 至 3.5 年。临床结局包括心脏事件（心源性死亡、心肌梗死、冠状动脉血运重建和心力衰竭住院）、非心源性死亡和非心源性住院。结果 总体而言，整体原始 T1、对比后 T1、ECV 和 T2 分别为 1,030 ± 56 ms、458 ± 84 ms、27 ± 4% 和 50 ± 4 ms。与下三分位范围 ECV (ECV <25%) 相比，上三分位范围 ECV (ECV >29%) 可独立预测不良临床结果（风险比 [HR]：2.87；95% 置信区间 [CI]：1.07 至7.68；p = 0.04）在具有左心室收缩末期容积和 LGE 的多变量模型中。调整左心室射血分数、左心室收缩末期容积和 LGE 后，较高的 T2（T2 ≥50.2 ms）可独立预测不良临床结果（HR：3.01；95% CI：1.39 至 6.54；p = 0.005）。此外，较高的 T2（T2 ≥50.2 ms）也可以独立预测心脏事件（HR：4.92；CI：1.60 至 15.14；p = 0。005）在具有左心室射血分数的多变量模型中。结论 心脏移植患者 MRI 衍生的心肌 ECV 和 T2 映射与心脏和非心脏结局独立相关。我们的研究结果强调需要进行更大规模的前瞻性研究。