Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

Open Access

Prognostic value of dual T1 mapping to predict adverse events in TAVR-patients: extra cellular volume as a possible predictor for peri- and post-TAVR adverse events

  • Jonathan Nadjiri2,
  • Eva Hendrich3,
  • Albrecht Will3,
  • Costanza Pellegrini1,
  • Oliver Husser1,
  • Christian Hengstenberg1,
  • Stefan Martinoff3 and
  • Martin Hadamitzky3
Journal of Cardiovascular Magnetic Resonance201618(Suppl 1):O64

https://doi.org/10.1186/1532-429X-18-S1-O64

Published: 27 January 2016

Background

The benefit of a transcatheter aortic valve replacement(TAVR) can differ in patients and therapy bears severe risks. Dual T1 mapping allows for a comprehensive assessment of myocardial tissue by quantification of extracellular volume (ECV) by measuring T1-relaxation before and after administration of Gadolinium(Gd). High degree aortic stenosis can lead to cardiac damage such as diffuse myocardial fibrosis, evaluable by ECV in CMR.

We sought to assess the prognostic value of T1 mapping and ECV to predict adverse events during and after TAVR.

Methods

Since July 2013, we investigated 105 patients undergoing clinically indicated TAVR by performing additional CMR with T1 mapping sequences. Examinations were performed one day before intervention. We used a Modified Look Locker Inversion Recovery (MOLLI) sequence with 3 inversion pulses and a 4-(1)-3-(1)-2 readout pattern. The post Gd scan for extra cellular volume calculation was performed 10 min. after administration of a bolus of 0.2 mmol/kg body weight gadopentetate dimeglumine. Study endpoints were all cause death, congestive heart failure (CHF) and TAVR associated conduction abnormalities defined as new onset of left bundle branch block (LBBB), AV-Block or implantation of a pacemaker.

Results

Median follow-up time was 191 days [IQR 59 - 361 days]. Out of 105 patients 97(92%) could be followed. During follow up 10 (10%) patients died, 5 (5%) patients required hospitalization due to CHF, in 17 (18%) patients a pacemaker was required, in 11(11%) patients a new onset of a LBBB was observed and 5(5%) patients had new onset of an AV-Block I. Occurrence of death and CHF had no statistically relevant association with BMI, age, gender, EuroScore or type of valve prosthesis, LV-mass, end diastolic volume, ejection fraction or fluoroscopy time.

ECV was increased (>30%) in 38 patients (40%).

There was no significant correlation between ECV and death, Hazard ratio (HR) 0.847[95% CI: 0.335; 2.14], p = 0.72. ECV in patients with subsequent CHF was higher than in those without an event (33.5 ± 4.6% and 29.1 ± 4.1% respectively), but the difference just did not reach the level of significance HR: 2.16[95% CI: 0.969; 4.84], p = 0.06.

Patients with post-TAVR conduction abnormality (LBBB, AV-block or pacemaker implantation) had statistically relevant lower ECV-values compared to those without an event. Patients with an event had a mean ECV of 28.1 ± 3.16%; patients without an event had a mean ECV of 29.8 ± 4.53, HR: 0.558[95% CI: 0.324; 0.962], p = 0.036.

Conclusions

In this study, elevated myocardial ECV is a predictor of CHF by trend, CMR may be helpful in identifying patients with a high risk for post-TAVR cardiac decompensation benefitting from an intensified postinterventional surveillance.

Patients with post-TAVR conductions abnormalities have a significantly decreased ECV. One possible explanation of this phenomenon could be that myocardial fibrosis may protect the conduction pathways from pressure caused by the valve prosthesis.

Figure 1

Figure 2

Authors’ Affiliations

(1)
Department of Cardiovascular Diseases, Deutsches Herzzentrum München
(2)
Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München
(3)
Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München

Copyright

© Nadjiri et al. 2016

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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