Background
Methods
Study subjects
CMR scanning protocol
CMR image analysis
Clinical follow-up
Statistical analysis
Results
Baseline characteristics and clinical outcome
Characteristics | Patients n = 82 | Healthy controls n = 20 |
P
|
---|---|---|---|
Clinical | |||
Male/female | 52/30 | 10/10 | 0.27 |
Age (years) | 55.5 ± 8.5 | 53.2 ± 11.7 | 0.30 |
NYHA (I/II/III/IV) | 30/24/23/5 | – | – |
cTnI (μg/L) | 0.043 (0.015–0.146) | 0.000 (0.000–0.040) | 0.024 |
NT-proBNP (pg/mL) | 2056 (348–6096) | 0 (0–23) | 0.001 |
dFLC (mg/L) | 138.0 (46.0–391.5) | – | – |
Mayo Stage (I/II/III/IV) | 22/18/29/13 | – | – |
Creatinine (umol/L) | 87.3 ± 21.6 | 74.9 ± 15.3 | 0.21 |
HTN/CHD/DM/Af | 16/6/3/2 | – | – |
Therapy (BCD/TCD/ASCT) | 5/4/2 | – | – |
Echocardiography | |||
E/A | 1.3 ± 0.7 | – | – |
E/E’ | 16.8 ± 8.3 | – | – |
Cardiac MR | |||
Indexed LVEDV (ml/m2) | 58.3 ± 16.0 | 74.5 ± 17.1 | 0.001 |
Indexed LVESV (ml/m2) | 22.1 ± 12.4 | 21.5 ± 8.1 | 0.79 |
LVEF (%) | 63.3 ± 14.6 | 70.3 ± 8.7 | 0.043 |
Left atrium area (cm2) | 21.4 ± 5.0 | 20.6 ± 5.0 | 0.52 |
Indexed left ventricle mass (g/m2) | 93.5 ± 29.0 | 65.2 ± 15.3 | 0.001 |
Septal thickness (mm) | 15.4 ± 4.0 | 10.5 ± 2.0 | 0.001 |
LGE (no/patchy/global) | 26/18/38 | – | – |
Native T1 (ms) | 1438 ± 120 | 1283 ± 46 | 0.001 |
ECV (%) | 43.9 ± 10.9 | 27.0 ± 1.7 | 0.001 |
Clinical and biochemical markers of severity
Univariate | Multivariate | Multivariate | ||||
---|---|---|---|---|---|---|
HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| |
Age, per 1 year increase | 1.059 (1.008–1.112) | 0.023 | 1.082 (1.022–1.144) | 0.006 | 1.063 (1.000–1.129) | 0.051 |
NYHA | 2.534 (1.581–4.062) | 0.001 | 1.569 (0.880–2.797) | 0.127 | 2.253 (1.385–3.666) | 0.001 |
log (cTnI), per unit increase | 2.568 (1.204–5.477) | 0.015 | – | – | – | – |
log (NT-proBNP), per unit increase | 3.122 (1.501–6.496) | 0.002 | – | – | – | – |
Mayo Stage | 2.111 (1.323–3.368) | 0.002 | 1.121 (0.603–2.081) | 0.718 | 1.525 (0.846–2.748) | 0.16 |
E/E’, per 1 unit increase | 1.089 (1.012–1.110) | 0.045 | 1.783 (0.334–9.501) | 0.498 | 1.722 (0.318–9.267) | 0.43 |
LVEF, per 1% increase | 0.961 (0.936–0.986) | 0.003 | 0.982 (0.948–1.017) | 0.307 | 0.983 (0.951–1.017) | 0.33 |
Septal thickness, per 1 mm increase | 1.132 (1.040–1.232) | 0.004 | 1.175 (1.035–1.335) | 0.013 | 1.130 (1.018–1.255) | 0.022 |
ECV ≥44.0% | 7.677 (2.256–26.128) | 0.001 | 7.249 (2.039–25.771) | 0.002 | – | – |
Global LGE | 5.047 (1.971–12.926) | 0.001 | – | – | 4.804 (1.751–13.179) | 0.002 |
CMR structural and functional parameters
LGE, native T1 and ECV
Bias | SD of bias | 95% CI | |
---|---|---|---|
Native T1 | |||
Intra-observer variability 1/ms | −5.60 | 16.40 | −37.04, 25.84 |
Intra-observer variability 2/ms | 4.20 | 19.74 | −34.49, 42.89 |
Inter-observer variability/ms | 6.12 | 18.33 | −32.88, 44.51 |
Repeated scan reproducibility/ms | 5.45 | 21.07 | −35.86, 46.76 |
ECV | |||
Intra-observer variability 1/% | 0.33 | 1.44 | −2.96, 3.02 |
Intra-observer variability 2/% | 0.27 | 1.87 | −2.41, 3.15 |
Inter-observer variability 1/% | −0.25 | 1.82 | −3.36, 2.80 |
Native T1 | ECV | LGE | ||||
---|---|---|---|---|---|---|
r or ρ |
P
| r or ρ |
P
| ρ |
P
| |
Clinical | ||||||
NYHA | 0.427 | 0.001 | 0.686 | 0.001 | 0.674 | 0.001 |
NT-proBNP | 0.351 | 0.001 | 0.707 | 0.001 | 0.729 | 0.001 |
Mayo Stage | 0.335 | 0.002 | 0.631 | 0.001 | 0.671 | 0.001 |
Echocardiography | ||||||
E/A | 0.060 | 0.65 | 0.309 | 0.20 | 0.330 | 0.20 |
E/E’ | 0.302 | 0.209 | 0.488 | 0.001 | 0.351 | 0.006 |
Cardiac MR | ||||||
Indexed LVEDV | −0.222 | 0.025 | −0.320 | 0.001 | −0.113 | 0.31 |
Indexed LVESV | −0.078 | 0.44 | 0.209 | 0.036 | 0.203 | 0.067 |
LVEF | 0.063 | 0.93 | −0.451 | 0.001 | −0.380 | 0.001 |
Left atrium area | 0.207 | 0.037 | 0.174 | 0.082 | 0.197 | 0.077 |
Indexed left ventricle mass | 0.360 | 0.001 | 0.633 | 0.001 | 0.590 | 0.001 |
Septal thickness | 0.440 | 0.001 | 0.626 | 0.001 | 0.654 | 0.001 |
Native T1 | – | – | 0.605 | 0.001 | – | – |
LGE | 0.420 | 0.001 | 0.867 | 0.001 | – | – |
Multivariate analysis
Univariate | Multivariate | Multivariate | ||||
---|---|---|---|---|---|---|
HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| |
Age, per 1 year increase | 1.053 (1.001–1.108) | 0.046 | 1.067 (1.012–1.125) | 0.011 | 1.060 (1.007–1.116) | 0.025 |
NYHA | 2.405 (1.450–3.988) | 0.001 | 1.752 (1.010–3.039) | 0.056 | 1.776 (0.924–3.414) | 0.085 |
Mayo Stage | 1.985 (1.212–3.252) | 0.006 | 1.406 (0.736–2.683) | 0.30 | 1.443 (0.779–2.672) | 0.24 |
E/E’, per 1 unit increase | 1.073 (1.003–1.114) | 0.042 | 1.235 (0.477–3.134) | 0.28 | 1.296 (0.463–3.188) | 0.40 |
LVEF, per 1% increase | 0.966 (0.939–0.994) | 0.016 | 0.995 (0.960–1.033) | 0.81 | 0.987 (0.954–1.021) | 0.44 |
Septal thickness, per 1 mm increase | 1.115 (1.020–1.219) | 0.017 | 1.112 (0.988–1.251) | 0.078 | 1.086 (0.973–1.213) | 0.041 |
ECV ≥44.0% | 4.751 (1.572–14.360) | 0.006 | 4.599 (1.493–14.165) | 0.008 | – | – |
Global LGE | 4.041 (1.452–11.246) | 0.007 | – | – | 4.442 (1.578–12.389) | 0.015 |