PMID- 32653543
OWN - NLM
STAT- MEDLINE
DCOM- 20210812
LR  - 20210812
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 13
IP  - 9
DP  - 2020 Sep
TI  - T(1) Mapping Tissue Heterogeneity Provides Improved Risk Stratification for ICDs 
      Without Needing Gadolinium in Patients With Dilated Cardiomyopathy.
PG  - 1917-1930
LID - S1936-878X(20)30313-2 [pii]
LID - 10.1016/j.jcmg.2020.03.014 [doi]
AB  - OBJECTIVES: This study sought to determine whether myocardial tissue 
      heterogeneity scanned by native T(1) mapping could improve risk stratification in 
      patients with nonischemic dilated cardiomyopathy (NICM) evaluated for primary 
      prevention by ICD. BACKGROUND: The benefit of insertable cardiac-defibrillator 
      (ICD) as primary prevention ICD in patients with NICM remains to be fully 
      clarified. METHODS: A total of 115 NICM candidates for primary prevention and 55 
      healthy controls with similar distributions of age and sex were prospectively 
      enrolled. Imaging was performed at 1.5-T using a protocol that included cine 
      magnetic resonance for left ventricular function, late gadolinium enhancement 
      (LGE) for focal scarring, and 5-slice native T(1) mapping for diffuse fibrosis 
      and heterogeneity. The last method was assessed by mean absolute deviation of the 
      segmental pixel-SD from the average pixel-SD (Mad-SD). The primary endpoint was a 
      composite of appropriate ICD therapy and sudden cardiac death. RESULTS: During a 
      median follow-up of 24 months, 13 patients (11%) experienced the primary 
      endpoint. Dichotomized Mad-SD >0.24 provided a comparable outcome to the presence 
      of LGE for the primary endpoint (annual event rate: 9.8% vs. 10.9%). The 
      integration of Mad-SD to global native T(1) showed excellent arrhythmic 
      event-free survival (annual event rate: 0%), and high sensitivity of 85% (95% 
      confidence interval [CI]: 55% to 98%) and moderate specificity of 72% (95% CI: 
      62% to 80%), with a C-statistic of 0.76 (95% CI: 0.64 to 0.87), which was 
      comparable to the presence, location, or extent of LGE in its ability to predict 
      arrhythmic events. CONCLUSIONS: Combined myocardium tissue heterogeneity and 
      interstitial fibrosis assessment by native T(1) mapping is an important predictor 
      of ventricular tachycardia and ventricular fibrillation and provides additive 
      risk stratification for primary prevention ICD in NICM patients without the need 
      for gadolinium contrast.
CI  - Copyright (c) 2020. Published by Elsevier Inc.
FAU - Nakamori, Shiro
AU  - Nakamori S
AD  - Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical 
      Center and Harvard Medical School, Boston, Massachusetts.
FAU - Ngo, Long H
AU  - Ngo LH
AD  - Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical 
      Center and Harvard Medical School, Boston, Massachusetts.
FAU - Rodriguez, Jennifer
AU  - Rodriguez J
AD  - Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical 
      Center and Harvard Medical School, Boston, Massachusetts.
FAU - Neisius, Ulf
AU  - Neisius U
AD  - Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical 
      Center and Harvard Medical School, Boston, Massachusetts.
FAU - Manning, Warren J
AU  - Manning WJ
AD  - Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical 
      Center and Harvard Medical School, Boston, Massachusetts; Radiology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
FAU - Nezafat, Reza
AU  - Nezafat R
AD  - Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical 
      Center and Harvard Medical School, Boston, Massachusetts. Electronic address: 
      rnezafat@bidmc.harvard.edu.
LA  - eng
GR  - R01 HL127015/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20200709
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2020 Sep;13(9):1931-1933. PMID: 32563649
MH  - *Cardiomyopathy, Dilated
MH  - Contrast Media
MH  - *Defibrillators, Implantable
MH  - Gadolinium
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Myocardium
MH  - Predictive Value of Tests
MH  - Risk Assessment
MH  - Risk Factors
OTO - NOTNLM
OT  - cardiac magnetic resonance
OT  - implantable cardioverter-defibrillator
OT  - native T(1)
OT  - nonischemic dilated cardiomyopathy
OT  - tissue heterogeneity
OT  - ventricular fibrillation
OT  - ventricular tachycardia
EDAT- 2020/07/13 06:00
MHDA- 2021/08/13 06:00
CRDT- 2020/07/13 06:00
PHST- 2019/10/16 00:00 [received]
PHST- 2020/02/27 00:00 [revised]
PHST- 2020/03/27 00:00 [accepted]
PHST- 2020/07/13 06:00 [pubmed]
PHST- 2021/08/13 06:00 [medline]
PHST- 2020/07/13 06:00 [entrez]
AID - S1936-878X(20)30313-2 [pii]
AID - 10.1016/j.jcmg.2020.03.014 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2020 Sep;13(9):1917-1930. doi: 
      10.1016/j.jcmg.2020.03.014. Epub 2020 Jul 9.