title: T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure.
abstract: OBJECTIVE
  The study sought to examine prognostic relevance of T1 mapping parameters (based on a T1 mapping method) in nonischemic dilated cardiomyopathy (NIDCM) and compare them with conventional markers of adverse outcome.
  
  
  BACKGROUND
  NIDCM is a recognized cause of poor clinical outcome. NIDCM is characterized by intrinsic myocardial remodeling due to complex pathophysiological processes affecting myocardium diffusely. Lack of accurate and noninvasive characterization of diffuse myocardial disease limits recognition of early cardiomyopathy and effective clinical management in NIDCM. Cardiac magnetic resonance (CMR) supports detection of diffuse myocardial disease by T1 mapping.
  
  
  METHODS
  This is a prospective observational multicenter longitudinal study in 637 consecutive patients with dilated NIDCM (mean age 50 years [interquartile range: 37 to 76 years]; 395 males [62%]) undergoing CMR with T1 mapping and late gadolinium enhancement (LGE) at 1.5-T and 3.0-T. The primary endpoint was all-cause mortality. A composite of heart failure (HF) mortality and hospitalization was a secondary endpoint.
  
  
  RESULTS
  During a median follow-up period of 22 months (interquartile range: 19 to 25 months), we observed a total of 28 deaths (22 cardiac) and 68 composite HF events. T1 mapping indices (native T1 and extracellular volume fraction), as well as the presence and extent of LGE, were predictive of all-cause mortality and HF endpoint (p < 0.001 for all). In multivariable analyses, native T1 was the sole independent predictor of all-cause and HF composite endpoints (hazard ratio: 1.1; 95% confidence interval: 1.06 to 1.15; hazard ratio: 1.1; 95% confidence interval: 1.05 to 1.1; p < 0.001 for both), followed by the models including the extent of LGE and right ventricular ejection fraction, respectively.
  
  
  CONCLUSIONS
  Noninvasive measures of diffuse myocardial disease by T1 mapping are significantly predictive of all-cause mortality and HF events in NIDCM. We provide a basis for a novel algorithm of risk stratification in NIDCM using a complementary assessment of diffuse and regional disease by T1 mapping and LGE, respectively.
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; King's College Hospital NHS Trust, London, England; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany; Department of Cardiac Imaging, King's College London, London, England. Electronic address: vppapers@icloud.com.
authors.forename: Valentina O
authors.initials: VO
authors.lastname: Puntmann
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; King's College Hospital NHS Trust, London, England.
authors.forename: Gerry
authors.initials: G
authors.lastname: Carr-White
authors.affiliation: St Vincent's University, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jabbour
authors.affiliation: St Vincent's University, Sydney, Australia.
authors.forename: Chung-Yao
authors.initials: CY
authors.lastname: Yu
authors.affiliation: German Heart Institute Berlin, Berlin, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.affiliation: German Heart Institute Berlin, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Hinojar
authors.affiliation: German Heart Institute Berlin, Berlin, Germany.
authors.forename: Adelina
authors.initials: A
authors.lastname: Doltra
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; Department of Cardiac Imaging, King's College London, London, England.
authors.forename: Niharika
authors.initials: N
authors.lastname: Varma
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; Department of Cardiac Imaging, King's College London, London, England.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Child
authors.affiliation: King's College Hospital NHS Trust, London, England; Department of Cardiac Imaging, King's College London, London, England.
authors.forename: Toby
authors.initials: T
authors.lastname: Rogers
authors.affiliation: King's College Hospital NHS Trust, London, England; Cardiovascular Division, King's College London, London, England.
authors.forename: Gonca
authors.initials: G
authors.lastname: Suna
authors.affiliation: Guys and St Thomas' NHS Trust, London, England.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arroyo Ucar
authors.affiliation: Guys and St Thomas' NHS Trust, London, England.
authors.forename: Ben
authors.initials: B
authors.lastname: Goodman
authors.affiliation: King's College Hospital NHS Trust, London, England; Cardiovascular Division, King's College London, London, England.
authors.forename: Sitara
authors.initials: S
authors.lastname: Khan
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; Department of Radiology, University of Bonn, Bonn, Germany.
authors.forename: Darius
authors.initials: D
authors.lastname: Dabir
authors.affiliation: Institute of Biostatistics and Mathematical Modelling at Goethe University Frankfurt; Frankfurt am Main, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Zeiher
authors.affiliation: Guys and St Thomas' NHS Trust, London, England; King's College Hospital NHS Trust, London, England; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany; Department of Cardiac Imaging, King's College London, London, England; Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D002423:Cause of Death; D018450:Disease Progression; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
keywords: T1 mapping; heart failure; late gadolinium enhancement; native T1; nonischemic cardiomyopathy; survival