Baseline native T1 values are associated with adverse outcome in a newly diagnosed, hospitalised heart failure patient population
Authors: Zheng A , Adam R D , Cowburn P J , Haydock P , Peebles C , Harden S , Shambrook J , Abbas A , Vedwan K , Adam G , Flett A S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Tissue characterisation by T1 mapping on Cardiac Magnetic Resonance (CMR) imaging is a non-invasive assessment of diffuse cardiac fibrosis and has been shown to predict outcome in Heart Failure (HF).

Purpose
There is a need for improved risk stratification that delivers more personalised care for HF patients. We conducted the first prospective study to investigate novel CMR tissue characterisation biomarkers and correlate to adverse outcome, in a cohort of patients hospitalised with a new HF diagnosis.

Methods
This was single centre observational study. Inclusion criteria were admission with signs and symptoms of HF, and LVEF ≤50% or elevated plasma NTproBNP and being treated with intravenous furosemide.
43 consecutive eligible participants were included and underwent comprehensive CMR to establish anatomy, function and myocardial tissue characteristics during their presentation admission.
Participants were managed according to best practice HF guidelines and underwent reviews at 6, 12–18 and 24–30 months. All clinically relevant event data e.g. death and rehospitalisation were recorded.
Baseline CMR volumes, function, presence of Late Gadolinium Enhancement (LGE) and T1 mapping values were compared between the adverse event group and no adverse event group. ‘Adverse event’ was defined as all-cause mortality or HF hospitalisation.

Results
The median follow-up of 43 participants was 24.4 months. 41 (95%) were diagnosed with HF with reduced EF and 2 (5%) with HF with preserved Ejection Fraction. Baseline clinical, biochemical characteristics and NYHA class were similar between the adverse event and no adverse event groups. There was no significant difference between baseline LVEF (37% vs. 23%; p = 0.339) or NTproBNP levels (4948 vs.5456; p = 0.929) between groups. There was high uptake of HF medical therapy in both groups. (Table 1)
9 participants (21%) experienced adverse events. There was a significantly higher proportion of Ischaemic Cardiomyopathy in the adverse event group (67% vs. 18%; p = 0.008) with lower indexed LV volumes and mass. Native septal T1 (ms) was significantly higher in the adverse event group compared with the no adverse event group (1035 vs.996 p = 0.045). (Table 1)
Receiver Operating Characteristic (ROC) analysis indicated a Native T1 cut-off value of 1022ms as most sensitive and specific. Kaplan-Meier survival analysis comparing those with Native T1 &lt;1022ms and those with Native T1 &gt;1022ms on their baseline CMR showed an adverse event-free survival benefit favouring the lower T1 value group (HR 11.4, p = 0.003 - Figure 1).

Conclusions
In a cohort of all-comer hospitalised patients with a new diagnosis of HF, followed up over a 24-month period, there was a high rate of adverse events. A higher native T1 value on baseline CMR was associated with worse outcome in terms of all-cause mortality or HF hospitalisation.