title: 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.
abstract: BACKGROUND
  Diffuse myocardial fibrosis may provide a substrate for the initiation and maintenance of ventricular arrhythmia. T1 mapping overcomes the limitations of the conventional delayed contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging technique by allowing quantification of diffuse fibrosis.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether myocardial tissue characterization using T1 mapping would predict ventricular arrhythmia in ischemic and non-ischemic cardiomyopathies.
  
  
  METHODS
  This was a prospective longitudinal study of consecutive patients receiving implantable cardioverter-defibrillators in a tertiary cardiac center. Participants underwent CMR myocardial tissue characterization using T1 mapping and conventional CE-CMR scar assessment before device implantation. The primary end point was an appropriate implantable cardioverter-defibrillator therapy or documented sustained ventricular arrhythmia.
  
  
  RESULTS
  One hundred thirty patients (71 ischemic and 59 non-ischemic) were included with a mean follow-up period of 430 ± 185 days (median 425 days; interquartile range 293 days). At follow-up, 23 patients (18%) experienced the primary end point. In multivariable-adjusted analyses, the following factors showed a significant association with the primary end point: secondary prevention (hazard ratio [HR] 1.70; 95% confidence interval [95% CI] 1.01-1.91), noncontrast T1(_native) for every 10-ms increment in value (HR 1.10; CI 1.04-1.16; 90-ms difference between the end point-positive and end point-negative groups), and Grayzone(_2sd-3sd) for every 1% left ventricular increment in value (HR 1.36; CI 1.15-1.61; 4% difference between the end point-positive and end point-negative groups). Other CE-CMR indices including Scar(_2sd), Scar(_FWHM), and Grayzone(_2sd-FWHM) were also significantly, even though less strongly, associated with the primary end point as compared with 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.
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom. Electronic address: zhong.chen@kcl.ac.uk.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom.
authors.forename: Tobias
authors.initials: T
authors.lastname: Voigt
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Eva
authors.initials: E
authors.lastname: Sammut
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom.
authors.forename: Catalina
authors.initials: C
authors.lastname: Tobon-Gomez
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Child
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Anoop
authors.initials: A
authors.lastname: Shetty
authors.affiliation: Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Julian
authors.initials: J
authors.lastname: Bostock
authors.affiliation: Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Cooklin
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.affiliation: Department of Cardiology, King's College Hospital NHS Trust, London, United Kingdom.
authors.forename: Francis
authors.initials: F
authors.lastname: Murgatroyd
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Gill
authors.affiliation: Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Gerry
authors.initials: G
authors.lastname: Carr-White
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schaeffter
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
authors.affiliation: Division of Imaging Science and Biomedical Engineering, Kings College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: C Aldo
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005355:Fibrosis; D006801:Humans; D008137:Longitudinal Studies; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D055502:Secondary Prevention; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006113:United Kingdom
keywords: Defibrillator; Gray zone; T1 mapping; Ventricular arrhythmia