International T1 Mapping Outcome Study

Multicenter Study on T1 Mapping for Prognostic Assessment in Cardiomyopathy

Overview

The International T1 Multicenter Cardiovascular Magnetic Resonance Study is a prospective observational multicenter longitudinal study examining the prognostic relevance of T1 mapping parameters in nonischemic dilated cardiomyopathy (NIDCM).

Background

T1 mapping is a robust CMR technique to quantify myocardial tissue composition. It provides information about:

  • Myocardial fibrosis (diffuse and focal)
  • Edema and inflammation
  • Extracellular volume (ECV) expansion

This study established reference values and demonstrated the prognostic value of native T1 and ECV measurements.

Study Design

  • Design: Prospective, observational, multicenter, longitudinal
  • Enrollment: 637 consecutive patients with nonischemic dilated cardiomyopathy
  • Patient characteristics: Mean age 50 years; 62% male
  • Imaging: CMR with T1 mapping and late gadolinium enhancement at 1.5T and 3.0T

Key Findings

Outcome Prediction

During median follow-up of 22 months:

  • 28 deaths observed (22 cardiac)
  • 68 composite heart failure events

Conclusion: Native T1 and ECV are stronger predictors of poor outcome in dilated cardiomyopathy than classic parameters. Native T1 was the strongest independent predictor of all-cause mortality and heart failure development.

Reference Values

The study also established standardized reference values for healthy human myocardium using the modified Look-Locker inversion recovery (MOLLI) technique across multiple vendors and field strengths.

Hypertrophic Phenotype Discrimination

Native T1 was shown to be an independent discriminator between hypertrophic cardiomyopathy and hypertensive heart disease, beyond ECV, wall thickness, and LV mass.

Key Publications

  1. Puntmann VO et al. T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure. JACC Cardiovasc Imaging 2016;9(1):40-50. DOI

  2. Dabir D et al. Reference values for healthy human myocardium using a T1 mapping methodology. J Cardiovasc Magn Reson 2014;16:69. DOI

  3. Puntmann VO et al. T1 Mapping in Discrimination of Hypertrophic Phenotypes. Circ Cardiovasc Imaging 2015;8:e003285. DOI

Participating Institutions

  • Institute of Experimental and Translational Cardiac Imaging, Goethe University Frankfurt
  • Guy’s and St. Thomas’ NHS Trust, London
  • King’s College Hospital NHS Trust, London
  • Additional international centers

Principal Investigators

  • PD Dr. Valentina O. Puntmann — University Hospital Frankfurt
  • Prof. Dr. Eike Nagel — University Hospital Frankfurt