Background
Diffuse myocardial fibrosis plays a key role in disease progression of heart failure with preserved ejection fraction (HFPEF). Recently it was shown that diffuse myocardial fibrosis is strongly related to post-contrast longitudinal relaxation (T1) time by cardiac magnetic resonance imaging (CMR). The aim of our study was to assess diffuse myocardial fibrosis by CMR T1-mapping in HFPEF patients and test its predictive value.
Methods
HFPEF was defined as serum NT-proBNP levels > 220 pg/ml, E/e by echocardiography ≥8, signs or symptoms of heart failure and preserved left ventricular ejection fraction (EF≥50%).
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63 HFPEF patients and 37 controls were prospectively evaluated. All patients underwent right heart catheterization. CMR studies included the assessment of cardiac function and dimensions by standard cine sequences. Myocardial T1-mapping was performed 15 minutes after a gadolinium bolus using an inversion recovery sequence.
Results
Post-contrast T1 was significantly correlated with variables reflecting left ventricular filling pressure (E/e p=0.001, R=-0.33; left atrial size, p=0.008, R=-0.27) and pulmonary vascular resistance (p=0.004, R=-0.36).
Patients were followed for a median (range) of 12.9 (0.5-23.1) months. By Kaplan-Meier analysis, event-free survival was significantly worse in patients with T1-times below the median of 388.2ms (log rank p=0.007). By multivariable Cox regression including baseline characteristics, invasive hemodynamics, renal function, and CMR imaging variables, only post-contrast T1 time (p=0.015) and left atrium area (p=0.029) remained independent predictors of event-free survival.
Conclusions
Our data suggest that post-contrast T1-mapping is a promising tool for the assessment of diffuse myocardial fibrosis. It is closely linked to variables reflecting impaired left ventricular relaxation and hemodynamic variables like pulmonary vascular resistance. Post-contrast T1 time in HFPEF patients outperformed invasive hemodynamics in the multivariable analysis as an independent predictor of event-free survival.
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Funding
none
Open Access
This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License (
https://creativecommons.org/licenses/by/2.0
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.