Combination of extracellular volume fraction by cardiac magnetic resonance imaging and QRS duration for the risk stratif
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ORIGINAL ARTICLE
Combination of extracellular volume fraction by cardiac magnetic resonance imaging and QRS duration for the risk stratification for patients with non‑ischemic dilated cardiomyopathy Sho Kodama1 · Shingo Kato1 · Keigo Hayakawa1 · Mai Azuma1 · Minako Kagimoto1 · Kohei Iguchi1 · Masahiro Fukuoka1 · Kazuki Fukui1 · Tae Iwasawa2 · Daisuke Utsunomiya3 · Masami Kosuge4 · Kazuo Kimura4 · Kouichi Tamura5 Received: 13 December 2019 / Accepted: 1 May 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract The extracellular volume fraction (ECV) by T1 mapping can quantify diffuse myocardial fibrosis, and useful as a noninvasive 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 0.30 or QRS > 120 ms; group 3: ECV > 0.30 and QRS > 120 ms). The Institutional Review Board of Kanagawa Cardiovascular and Respiratory Center approved this study and waived the need for informed consent. However, all patients had the option not to include their clinical data in the study.
CMR image acquisition All MR images were acquired from patients using a 1.5-T MRI scanner equipped with 32-channel cardiac coils (Achieva; Philips Healthcare, Best, The Netherlands). Cine MRI, LGE MRI, and T1 mapping images were obtained from all subjects. To assess the LV volume and LV systolic function, vertical long-axis, horizontal long-axis, and shortaxis cine images of the LV were acquired using a steadystate free precession sequence, (repetition time, 4.1 ms; echo time, 1.7 ms; flip angle, 55°; field of view, 350 × 350 mm2; acquisition matrix, 128 × 128; number of phases per cardiac cycle, 20). A total of 0.15 mmol/kg of gadolinium contrast was injected into each patient. Fifteen minutes thereafter, the LGE MRI images were acquired in the same planes a
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