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Ma S, Zhou J, Pu C, Wang F, Hu Q, Wu Y, Yu F, Zhang L, He C, Hu H. CMR-based T2 RV/LV blood pool ratio: Help for risk stratification in heart failure. Eur J Radiol 2025; 189:112178. [PMID: 40449458 DOI: 10.1016/j.ejrad.2025.112178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 04/07/2025] [Accepted: 05/14/2025] [Indexed: 06/03/2025]
Abstract
OBJECTIVES Blood pool signals on T2 map can reflect intracardiac blood oxygenation. This study aimed to evaluate the T2 RV/LV blood pool ratio (T2 ratio) as a potential parameter for risk stratification in heart failure (HF) patients. METHODS 217 HF patients undergoing cardiac MRI were categorized into major adverse cardiovascular events (MACE) and No MACE groups. Regions of interest were delineated in the bi-ventricular blood pools on T2 maps to calculate T2 ratios. Clinical and imaging parameters were compared between groups, and independent predictors of MACE were identified using Cox regression analysis. Associations between T2 ratios and other parameters were explored. Survival analyses were conducted across low, moderate, and high-risk groups. Finally, predictive performance for MACE was compared among different models. RESULTS The T2 ratio was lower in MACE group (0.65 ± 0.12 vs 0.75 ± 0.12, P < 0.001) and was identified as an independent prognostic predictor of adverse outcomes in HF (HR: 0.966, P = 0.044). The association between T2 ratio and left ventricular ejection fraction (LVEF) followed distinct patterns in different ranges, with a transition around LVEF ≈ 50 %. Survival analysis demonstrated a stepwise decline in event-free survival from low- to high-risk groups (P < 0.05). Finally, the predictive model G incorporating myocardial T1 and T2 ratio demonstrated superior predictive efficacy (C-statistic: 0.806, IBS: 0.087). CONCLUSIONS A lower T2 ratio was associated with a higher risk of MACE in HF patients. This parameter may serve as a valuable tool for risk stratification in clinical practice.
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Affiliation(s)
- Siying Ma
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Junjie Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fuyan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiuhui Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Feidan Yu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lingjie Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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Lunzer L, Donà C, Mascherbauer K, Kronberger C, Nitsche C, Koschutnik M, Poledniczek M, Harbich PF, Kaufmann C, Pogran E, Kvakan H, Beitzke D, Loewe C, Geppert A, Hengstenberg C, Kammerlander AA. Renal T1 Times on Cardiac Magnetic Resonance Reflect Renal Dysfunction and Are Associated with Adverse Outcomes: Insights from an All-Comer Cohort. J Clin Med 2024; 14:154. [PMID: 39797237 PMCID: PMC11722338 DOI: 10.3390/jcm14010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/24/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Background: Renal disease is common in patients with cardiovascular disease (CVD) and is associated with adverse outcomes. Cardiac magnetic resonance (CMR) with advanced mapping techniques is the gold standard for characterizing myocardial tissue, and renal tissue is often visualized on these maps. However, it remains unclear whether renal T1 times accurately reflect renal dysfunction or predict adverse outcomes. Aim: To analyze the relationship between renal T1 times, renal dysfunction, and adverse outcomes. Adverse outcomes were defined as all-cause and cardiovascular death. Methods: Renal T1 times were measured in the native short-axis view in an all-comers cohort undergoing CMR. Renal function parameters were assessed at the time of CMR. Results: A total of 506 patients (mean age 60 ± 15 years, 53% male) were included in the analysis. A significant correlation was observed between log10 renal cortical T1 times and eGFR (r = -0.701, p < 0.001) and creatinine (r = 0.615, p < 0.001). Kaplan-Meier analysis showed an increased risk of all-cause (p < 0.001 by log-rank test) and cardiovascular mortality (p = 0.004 by log-rank test) in patients with renal cortical T1 times above the median. In the univariable Cox regression analysis, there was a significant association between renal cortical T1 times and increased risk of all-cause (HR = 1.73 [95% CI, 1.42-2.11] per every 100 ms increase p < 0.001) and cardiovascular mortality (HR = 1.41 [95% CI, 1.05-1.90] per every 100 ms increase, p = 0.021). This association remained statistically significant after adjustment for prespecified clinical factors (adjusted HR for all-cause death = 1.49 [95% CI, 1.10-2.02] per every 100 ms increase, p = 0.01; adjusted HR for cardiovascular death = 1.42 [95% CI, 1.05-1.90] per every 100 ms increase, p = 0.021). Conclusions: Our results indicate that there is a significant association between increased renal cortical T1 times and impaired renal function, as well as an increased risk of all-cause and cardiovascular mortality, although it should be noted that our results are preliminary and need to be validated in external cohorts performing renal biopsies.
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Affiliation(s)
- Laura Lunzer
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
- Medical Department, Division of Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria; (P.F.H.); (C.K.); (E.P.); (H.K.); (A.G.)
| | - Carolina Donà
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Katharina Mascherbauer
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Christina Kronberger
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Christian Nitsche
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Matthias Koschutnik
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Michael Poledniczek
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Paul Felix Harbich
- Medical Department, Division of Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria; (P.F.H.); (C.K.); (E.P.); (H.K.); (A.G.)
| | - Christoph Kaufmann
- Medical Department, Division of Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria; (P.F.H.); (C.K.); (E.P.); (H.K.); (A.G.)
| | - Edita Pogran
- Medical Department, Division of Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria; (P.F.H.); (C.K.); (E.P.); (H.K.); (A.G.)
| | - Heda Kvakan
- Medical Department, Division of Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria; (P.F.H.); (C.K.); (E.P.); (H.K.); (A.G.)
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (D.B.); (C.L.)
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (D.B.); (C.L.)
| | - Alexander Geppert
- Medical Department, Division of Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria; (P.F.H.); (C.K.); (E.P.); (H.K.); (A.G.)
| | - Christian Hengstenberg
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
| | - Andreas Anselm Kammerlander
- Medical Department, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (L.L.); (K.M.); (C.K.); (C.N.); (M.K.); (M.P.); (C.H.); (A.A.K.)
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