Prognostic value of cardiovascular magnetic resonance T1 mapping and extracellular volume fraction in nonischemic dilated cardiomyopathy.

BACKGROUND: Heart failure- (HF) and arrhythmia-related complications are the main causes of morbidity and mortality in patients with nonischemic dilated cardiomyopathy (NIDCM). Cardiovascular magnetic resonance (CMR) imaging is a noninvasive tool for risk stratification based on fibrosis assessment. Diffuse interstitial fibrosis in NIDCM may be a limitation for fibrosis assessment through late gadolinium enhancement (LGE), which might be overcome through quantitative T1 and extracellular volume (ECV) assessment. T1 and ECV prognostic value for arrhythmia-related events remain poorly investigated. We asked whether T1 and ECV have a prognostic value in NIDCM patients. METHODS: This prospective multicenter study analyzed 225 patients with NIDCM confirmed by CMR who were followed up for 2 years. CMR evaluation included LGE, native T1 mapping and ECV values. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE) which was divided in two groups: HF-related events and arrhythmia-related events. Optimal cutoffs for prediction of MACE occurrence were calculated for all CMR quantitative values. RESULTS: Fifty-eight patients (26%) developed a MACE during follow-up, 42 patients (19%) with HF-related events and 16 patients (7%) arrhythmia-related events. T1 Z-score (p = 0.008) and global ECV (p = 0.001) were associated with HF-related events occurrence, in addition to left ventricular ejection fraction (p < 0.001). ECV > 32.1% (optimal cutoff) remained the only CMR independent predictor of HF-related events occurrence (HR 2.15 [1.14-4.07], p = 0.018). In the arrhythmia-related events group, patients had increased native T1 Z-score and ECV values, with both T1 Z-score > 4.2 and ECV > 30.5% (optimal cutoffs) being independent predictors of arrhythmia-related events occurrence (respectively, HR 2.86 [1.06-7.68], p = 0.037 and HR 2.72 [1.01-7.36], p = 0.049). CONCLUSIONS: ECV was the sole independent predictive factor for both HF- and arrhythmia-related events in NIDCM patients. Native T1 was also an independent predictor in arrhythmia-related events occurrence. The addition of ECV and more importantly native T1 in the decision-making algorithm may improve arrhythmia risk stratification in NIDCM patients. Trial registration NCT02352129. Registered 2nd February 2015-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02352129.

Simultaneous multi-slice cardiac cine with Fourier-encoded self-calibration at 7 Tesla.

PURPOSE: To accelerate cardiac cine at 7 tesla using simultaneous multi-slice (SMS) acquisition with self-calibration to resolve misalignment between calibration and imaging data due to breathing motion. METHODS: A spoiled-gradient echo cine sequence was modified with radiofrequency phase-cycled SMS excitations. A Fourier encoding strategy was applied along the cardiac phase dimension to allow for slice untangling and split-slice GRAPPA calibration. Split-slice GRAPPA was coupled with regular GRAPPA (SMS-GRAPPA) and L1-SPIRiT (SMS-L1SPIRiT) for image reconstruction. 3-slice SMS cine MRI was evaluated in ten subjects against single-slice cine MRI in terms of SNR and contrast-to-noise ratio and slice leakage. RESULTS: SNR decreased significantly from 10.1 ± 7.1 for single-slice cine to 7.4 ± 2.8 for SMS-GRAPPA (P = 0.02) and was recovered to 9.0 ± 4.5 with SMS-L1SPIRiT (P = 0.02). Contrast to noise ratio decreased significantly from 14.5 ± 8.1 for single-slice cine to 5.6 ± 3.6 for SMS-GRAPPA (P < 0.0001) and increased slightly but significantly back to 6.7 ± 4.4 for SMS-L1SPIRiT (P = 0.03). Specific absorption rate restrictions imposed a reduced nominal flip angle (-37 ± 7%, P = 0.02) for 3-slice SMS excitations compared to single-slice acquisitions. SMS slice leakage increased significantly from apex (8.6 ± 6.5 %) to base (13.1 ± 4.1 %, P = 0.03) in the left ventricle. CONCLUSION: Three-fold acceleration of cine at 7T was achieved using the proposed SMS technique. Fourier encoding self-calibration and regularized image reconstruction enabled simultaneous acquisition of three slices without significant SNR decrease but significant CNR decrease linked to the reduced nominal excitation flip angle.