title: Cardiac magnetic resonance postcontrast T1 time is associated with outcome in patients with heart failure and preserved ejection fraction.
abstract: BACKGROUND
  The underlying pathophysiology of heart failure with preserved ejection fraction (HFPEF) is incompletely understood, but myocardial extracellular matrix accumulation is thought to play a major role. Our aims were to estimate myocardial extracellular matrix using cardiac magnetic resonance T1 mapping and to assess the relationship between pathobiology/pathophysiology and prognosis.
  
  
  RESULTS
  Patients with suspected HFPEF (n=100) were enrolled in this prospective, observational study. Confirmatory diagnostic tests, cardiac magnetic resonance imaging including T1 mapping, and invasive hemodynamic assessments were performed at baseline. Sixty-one patients with confirmed HFPEF entered a longitudinal outcome-monitoring phase (mean, 22.9±5.0 months), during which 16 had a cardiac event. Cardiac magnetic resonance T1 time (hazard ratio, 0.99; 95% confidence interval, 0.98-0.99; P=0.046), left atrial area (hazard ratio, 1.08; 95% confidence interval, 1.03-1.13; P<0.01), and pulmonary vascular resistance (hazard ratio, 1.01; 95% confidence interval, 1.00-1.01; P=0.03) were significantly associated with cardiac events. Patients with T1 times below the median (<388.3 ms) were at greater risk of cardiac events than the rest of the group (P<0.01). Extracellular matrix of left ventricular biopsies (n=9), quantified by TissueFAXS technology correlated with T1 time (R=0.98; P<0.01). T1 time also correlated with right ventricular-pulmonary arterial coupling (pulmonary vascular resistance: R=-0.36; P<0.01; right ventricular ejection fraction: R=0.28; P=0.01).
  
  
  CONCLUSIONS
  In the present preliminary study, cardiac magnetic resonance postcontrast T1 time is associated with prognosis in HFPEF, suggesting postcontrast T1 as possible biomarker for HFPEF.
authors.affiliation: Departments of Cardiology.
authors.forename: Julia
authors.initials: J
authors.lastname: Mascherbauer
authors.forename: Beatrice A
authors.initials: BA
authors.lastname: Marzluf
authors.forename: Caroline
authors.initials: C
authors.lastname: Tufaro
authors.forename: Stefan
authors.initials: S
authors.lastname: Pfaffenberger
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.forename: Paul
authors.initials: P
authors.lastname: Wexberg
authors.forename: Adelheid
authors.initials: A
authors.lastname: Panzenböck
authors.forename: Johannes
authors.initials: J
authors.lastname: Jakowitsch
authors.forename: Christine
authors.initials: C
authors.lastname: Bangert
authors.forename: Daniela
authors.initials: D
authors.lastname: Laimer
authors.forename: Catharina
authors.initials: C
authors.lastname: Schreiber
authors.forename: Gültekin
authors.initials: G
authors.lastname: Karakus
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Diana
authors.initials: D
authors.lastname: Bonderman
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: hypertension, pulmonary; magnetic resonance imaging; prognosis