Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China.
Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China.
Eur Radiol. 2022 Oct;32(10):6878-6890. doi: 10.1007/s00330-022-08839-8. Epub 2022 May 12.
This study aimed to evaluate the association of myocardial characterization by native T1 mapping using cardiac MR (CMR) with the incidence of major adverse cardiovascular event (MACE) in end-stage renal dysfunction (ESRD) patients on hemodialysis.
A total of 52 ESRD patients and 52 healthy individuals were prospectively recruited between June 2017 and June 2018. ESRD patients underwent CMR examinations post-hemodialysis for the evaluation of cardiac function and global native T1 mapping. Demographics, serum biomarkers, and coronary artery calcification were collected. MACE including all-caused death, and new onset of myocardial infarction, heart failure leading to hospitalization, fatal arrhythmia, and cardiac arrest was set as the endpoint.
During a median follow-up of 38.0 months, 13 patients (25.0%) reached the endpoints. Global native T1 mapping in patients on hemodialysis was significantly higher compared with that of healthy individuals (1280.3 ms ± 45.3 vs. 1238.2 ms ± 31.1, p < 0.001). In the univariate Cox regression analysis, global native T1 mapping (HR [hazard ratios]: 1.887, 95% CI [confidence interval]: 1.302-2.736, p = 0.001) was associated with the prediction of MACE. Multivariate Cox regression analysis demonstrated that global native T1 mapping (HR: 1.580, 95% CI: 1.112-2.244, p = 0.011) and age (HR: 1.088, 95% CI: 1.032-1.146, p = 0.002) were associated with the incidence of MACE after adjusting for other conventional risk factors.
Global native T1 mapping by CMR can potentially become a novel predictor of MACE in ESRD patients on hemodialysis, providing additional prognostic values over conventional risk factors. However, this conclusion should be validated in a larger sample size of hemodialysis patients.
• Global native T1 mapping was significantly higher in ESRD patients on hemodialysis compared with that of normal controls. • Global native T1 mapping was associated with myocardial enzymes, myocardial hypertrophy, coronary calcification, and cardiac function. • Global native T1 mapping value was independently predictive of MACE in hemodialysis patients, providing additional prognostic values over conventional risk factors.
本研究旨在评估心脏磁共振（CMR）心肌组织固有 T1 mapping 对血液透析终末期肾功能衰竭（ESRD）患者主要不良心血管事件（MACE）发生率的影响。
本研究共纳入 52 名 ESRD 患者和 52 名健康对照者，于 2017 年 6 月至 2018 年 6 月期间进行前瞻性招募。ESRD 患者在血液透析后接受 CMR 检查，以评估心功能和整体心肌固有 T1 mapping。收集人口统计学、血清生物标志物和冠状动脉钙化等数据。将包括全因死亡、新发心肌梗死、心力衰竭导致住院、致命性心律失常和心脏骤停在内的 MACE 作为终点事件。
中位随访 38.0 个月期间，有 13 名患者（25.0%）达到了终点事件。与健康对照组相比，血液透析患者的整体心肌固有 T1 mapping 值明显升高（1280.3 ms ± 45.3 比 1238.2 ms ± 31.1，p < 0.001）。单因素 Cox 回归分析显示，整体心肌固有 T1 mapping（HR [风险比]：1.887，95% CI [置信区间]：1.302-2.736，p = 0.001）与 MACE 的预测相关。多因素 Cox 回归分析显示，整体心肌固有 T1 mapping（HR：1.580，95% CI：1.112-2.244，p = 0.011）和年龄（HR：1.088，95% CI：1.032-1.146，p = 0.002）与调整其他传统危险因素后 MACE 的发生相关。
CMR 心肌固有 T1 mapping 可成为血液透析 ESRD 患者 MACE 的新型预测指标，提供比传统危险因素更有价值的预后信息。然而，这一结论还需要在更大的血液透析患者样本中进行验证。
与正常对照组相比，血液透析的 ESRD 患者的整体心肌固有 T1 mapping 值明显升高。
整体心肌固有 T1 mapping 与心肌酶、心肌肥厚、冠状动脉钙化和心功能相关。
整体心肌固有 T1 mapping 值可独立预测血液透析患者的 MACE，提供比传统危险因素更有价值的预后信息。
