Combination of extracellular volume fraction by cardiac magnetic resonance imaging and QRS duration for the risk stratification for patients with ... View Full Text


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Article Info

DATE

2020-05-16

AUTHORS

Sho Kodama, Shingo Kato, Keigo Hayakawa, Mai Azuma, Minako Kagimoto, Kohei Iguchi, Masahiro Fukuoka, Kazuki Fukui, Tae Iwasawa, Daisuke Utsunomiya, Masami Kosuge, Kazuo Kimura, Kouichi Tamura

ABSTRACT

The extracellular volume fraction (ECV) by T1 mapping can quantify diffuse myocardial fibrosis, and useful as a non-invasive marker for risk stratification for patients with non-ischemic dilated cardiomyopathy (NIDCM). Prolonged QRS interval on electrocardiogram is related to worse clinical outcome for heart failure patients. The purpose of this study was to evaluate the prognostic value of the combination of ECV and QRS duration for NIDCM patients. A total of 60 NIDCM patients (mean age 61 ± 12 years, mean left ventricular ejection fraction 37 ± 10%, mean QRS duration 110 ± 19 ms) were enrolled. Using a 1.5-T MR scanner and 32-channel cardiac coils, the mean ECV value of six myocardial segments at the mid-ventricular level was measured by the modified look-locker inversion recovery method. Adverse events were defined as follows: cardiac death; recurrent hospitalization due to heart failure. Patients were allocated into three groups based on ECV value and QRS duration (group 1: ECV ≦ 0.30 and QRS ≦ 120 ms; group 2: ECV > 0.30 or QRS > 120 ms; group 3: ECV > 0.30 and QRS > 120 ms). During a median follow-up duration of 370 days, 7 of 60 (12%) NIDCM patients experienced adverse events. NIDCM patients with events had longer QRS duration (134 ± 31 ms vs. 106 ± 14 ms, p = 0.01) and higher ECV (0.34 ± 0.07 vs 0.29 ± 0.05, p = 0.026) compared with those without events. On Kaplan–Meier curve analysis, significant difference was found between group 1 and group 3 (p < 0.001, log-rank test). No significant difference was found between group 1 and group 2 (p = 0.053), group 2 and group 3 (p = 0.115). The area under the receiver operating characteristic curve (AUC) for predicting adverse events was 0.778 (95% confidence interval CI 0.612–0.939) for ECV, 0.792 (95% CI 0.539–0.924) for QRS duration, 0.822 (95% CI 0.688–0.966) for combination of ECV and QRS duration. NIDCM patients with high ECV and prolonged QRS duration had significantly worse prognosis compared to those with normal ECV and normal QRS duration. The combination of ECV and QRS duration could be useful as a non-invasive method for better risk stratification for patients with NIDCM. More... »

PAGES

1439-1445

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-020-01618-9

DOI

http://dx.doi.org/10.1007/s00380-020-01618-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1127654499

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32417957


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30 schema:description The extracellular volume fraction (ECV) by T1 mapping can quantify diffuse myocardial fibrosis, and useful as a non-invasive marker for risk stratification for patients with non-ischemic dilated cardiomyopathy (NIDCM). Prolonged QRS interval on electrocardiogram is related to worse clinical outcome for heart failure patients. The purpose of this study was to evaluate the prognostic value of the combination of ECV and QRS duration for NIDCM patients. A total of 60 NIDCM patients (mean age 61 ± 12 years, mean left ventricular ejection fraction 37 ± 10%, mean QRS duration 110 ± 19 ms) were enrolled. Using a 1.5-T MR scanner and 32-channel cardiac coils, the mean ECV value of six myocardial segments at the mid-ventricular level was measured by the modified look-locker inversion recovery method. Adverse events were defined as follows: cardiac death; recurrent hospitalization due to heart failure. Patients were allocated into three groups based on ECV value and QRS duration (group 1: ECV ≦ 0.30 and QRS ≦ 120 ms; group 2: ECV > 0.30 or QRS > 120 ms; group 3: ECV > 0.30 and QRS > 120 ms). During a median follow-up duration of 370 days, 7 of 60 (12%) NIDCM patients experienced adverse events. NIDCM patients with events had longer QRS duration (134 ± 31 ms vs. 106 ± 14 ms, p = 0.01) and higher ECV (0.34 ± 0.07 vs 0.29 ± 0.05, p = 0.026) compared with those without events. On Kaplan–Meier curve analysis, significant difference was found between group 1 and group 3 (p < 0.001, log-rank test). No significant difference was found between group 1 and group 2 (p = 0.053), group 2 and group 3 (p = 0.115). The area under the receiver operating characteristic curve (AUC) for predicting adverse events was 0.778 (95% confidence interval CI 0.612–0.939) for ECV, 0.792 (95% CI 0.539–0.924) for QRS duration, 0.822 (95% CI 0.688–0.966) for combination of ECV and QRS duration. NIDCM patients with high ECV and prolonged QRS duration had significantly worse prognosis compared to those with normal ECV and normal QRS duration. The combination of ECV and QRS duration could be useful as a non-invasive method for better risk stratification for patients with NIDCM.
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36 schema:keywords ECV values
37 Kaplan-Meier curve analysis
38 MR scanner
39 NIDCM
40 NIDCM patients
41 QRS duration
42 QRS interval
43 T1 mapping
44 adverse events
45 analysis
46 area
47 better risk stratification
48 cardiac coil
49 cardiac death
50 cardiac magnetic resonance imaging
51 cardiomyopathy
52 characteristic curve
53 clinical outcomes
54 coil
55 combination
56 curve analysis
57 curves
58 days
59 death
60 differences
61 duration
62 electrocardiogram
63 events
64 extracellular volume fraction
65 failure
66 failure patients
67 fibrosis
68 follow
69 fraction
70 group
71 group 1
72 group 2
73 group 3
74 heart failure
75 heart failure patients
76 higher extracellular volume fractions
77 hospitalization
78 imaging
79 interval
80 inversion recovery method
81 levels
82 longer QRS duration
83 magnetic resonance imaging
84 mapping
85 markers
86 mean ECV values
87 median follow
88 method
89 mid-ventricular level
90 myocardial fibrosis
91 myocardial segments
92 non-invasive marker
93 non-invasive method
94 normal QRS duration
95 outcomes
96 patients
97 prognosis
98 prognostic value
99 purpose
100 receiver
101 recovery method
102 recurrent hospitalizations
103 resonance imaging
104 risk stratification
105 scanner
106 segments
107 significant differences
108 stratification
109 study
110 total
111 values
112 volume fraction
113 worse clinical outcomes
114 worse prognosis
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