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Myocardial tissue characterization by cardiac magnetic resonance imaging using T1 mapping predicts ventricular arrhythmia in ischemic and non-ischemic cardiomyopathy patients with implantable cardioverter defibrillators

Research output: Contribution to journalArticle

Zhong Chen, Manav Sohal, Tobias Voigt, Eva Sammut, Catalina Tabon-Gomez, Nick Child, T. Jackson, A. Shetty, Julian Bostock, Michael Cooklin, Mark O'Neil, Mark Wright, Francis Murgatroyd, Jaswinder Gill, Gerry S. Carr-White, Amedeo Chiribiri, Tobias Schaeffter, Reza Razavi, Christopher Aldo Rinaldi

Original languageEnglish
Pages (from-to)792-801
Number of pages10
JournalHeart rhythm : the official journal of the Heart Rhythm Society
Volume12
Issue number4
Early online date19 Dec 2014
DOIs
E-pub ahead of print19 Dec 2014
PublishedApr 2015

King's Authors

Abstract

Background
Diffuse myocardial fibrosis may provide substrate for the initiation and maintenance of ventricular arrhythmia. T1 mapping overcomes the limitations of the conventional delayed contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) technique by allowing quantification of diffuse fibrosis. We assessed whether myocardial tissue characterization using T1 mapping would predict ventricular arrhythmia in ischemic and non-ischemic cardiomyopathy.

Methods
A prospective longitudinal study of consecutive patients receiving implantable cardioverter defibrillators (ICD) in a tertiary cardiac center. Participants underwent CMR myocardial tissue characterization using T1 mapping and conventional CE-CMR scar assessment prior to device implantation. The primary endpoint was appropriate ICD therapy or documented sustained ventricular arrhythmia.

Results
One hundred and thirty patients (71 ischemic; 59 non-ischemic) were included with a mean follow-up period of 430±185 days (median: 425 days; IQR: 293 days). At follow-up, 23 (18%) patients experienced the primary endpoint. In multivariable-adjusted analyses, the following factors showed a significant association with the primary endpoint: secondary prevention (hazard ratio [HR] 1.70, confidence interval [CI] 1.01-1.91), non-contrast T1_Native for every 10ms increment in value (HR 1.10, CI 1.04-1.16; 90ms difference between the endpoint positive and negative groups), and grayzone_2sd-3sd for every 1% LV increment in value (HR 1.36, CI 1.15-1.61; 4% difference between the endpoint positive and negative groups). Other CE-CMR indices including scar_2sd, scar_FWHM and grayzone_2sd-FWHM were also significantly, albeit less strongly, associated with the primary endpoint as compared to grayzone_2sd-3sd.

Conclusions
Quantitative myocardial tissue assessment using T1 mapping is an independent predictor of ventricular arrhythmia in both ischemic and non-ischemic cardiomyopathies.

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