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Effect of Myocardial Tissue Characterization Using Native T1 to Predict the Occurrence of Adverse Events in Patients With Chronic Kidney Disease and Severe Aortic Stenosis

      Among patients with chronic kidney disease (CKD), aortic stenosis (AS) is associated with a significantly higher rate of mortality. We aimed to evaluate whether diffuse myocardial fibrosis, determined using native T1 mapping, has prognostic utility in predicting major adverse cardiovascular events (MACEs), including all-cause mortality or heart failure hospitalization, in patients with CKD and severe AS who are evaluated for transcatheter aortic valve implantation. Cardiac magnetic resonance with T1 mapping using the modified Look-Locker inversion recovery technique was performed in 117 consecutive patients with severe AS and CKD (stage ≥3). Patients were followed up to determine the occurrence of MACE. The mean age of the 117 patients in the cohort was 82 ± 8 years. Native T1 was 1,055 ms (25th- to 75th percentiles 1,031 to 1,078 ms), which is higher than previously reported in healthy controls. Patients with higher T1 times were more likely to have higher N-terminal pro-B-type natriuretic peptide levels (4,122 [IQR 1,578 to 7,980] pg/ml vs 1,678 [IQR 493 to 2,851] pg/ml, p = 0.005) and a history of heart failure (33% vs 9%, p = 0.034). After median follow-up of 3.4 years, MACE occurred in 71 patients (61%). The Society of Thoracic Surgeons predicted risk of mortality score (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.02 to 1.12, p = 0.006), native T1 >1,024 ms (HR 2.10, 95% CI 1.09 to 4.06, p = 0.028), and New York Heart Association class (HR 1.56, 95% 1.09 to 2.34, p = 0.016) were independent predictors of MACE. Longer native T1 was associated with MACE occurrence in patients with CKD and severe AS.
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      References

        • Otto CM
        • Prendergast B.
        Aortic-valve stenosis–from patients at risk to severe valve obstruction.
        N Engl J Med. 2014; 371: 744-756
        • Nishimura RA
        • Otto CM
        • Bonow RO
        • Carabello BA
        • Erwin 3rd, JP
        • Fleisher LA
        • Jneid H
        • Mack MJ
        • McLeod CJ
        • O'Gara PT
        • Rigolin VH
        • Sundt 3rd, TM
        • Thompson A
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines.
        J Am Coll Cardiol. 2017; 70: 252-289
        • Baumgartner H
        • Falk V
        • Bax JJ
        • De Bonis M
        • Hamm C
        • Holm PJ
        • Iung B
        • Lancellotti P
        • Lansac E
        • Rodriguez Muñoz D
        • Rosenhek R
        • Sjögren J
        • Tornos Mas P
        • Vahanian A
        • Walther T
        • Wendler O
        • Windecker S
        • Zamorano JL
        • ESC Scientific Document Group
        2017 ESC/EACTS Guidelines for the management of valvular heart disease.
        Eur Heart J. 2017; 38: 2739-2791
        • Everett RJ
        • Treibel TA
        • Fukui M
        • Lee H
        • Rigolli M
        • Singh A
        • Bijsterveld P
        • Tastet L
        • Musa TA
        • Dobson L
        • Chin C
        • Captur G
        • Om SY
        • Wiesemann S
        • Ferreira VM
        • Piechnik SK
        • Schulz-Menger J
        • Schelbert EB
        • Clavel MA
        • Newby DE
        • Myerson SG
        • Pibarot P
        • Lee S
        • Cavalcante JL
        • Lee SP
        • McCann GP
        • Greenwood JP
        • Moon JC
        • Dweck MR.
        Extracellular myocardial volume in patients with aortic stenosis.
        J Am Coll Cardiol. 2020; 75: 304-316
        • Bull S
        • White SK
        • Piechnik SK
        • Flett AS
        • Ferreira VM
        • Loudon M
        • Francis JM
        • Karamitsos TD
        • Prendergast BD
        • Robson MD
        • Neubauer S
        • Moon JC
        • Myerson SG.
        Human non-contrast T1 values and correlation with histology in diffuse fibrosis.
        Heart. 2013; 99: 932-937
        • Patel KK
        • Shah SY
        • Arrigain S
        • Jolly S
        • Schold JD
        • Navaneethan SD
        • Griffin BP
        • Nally JV
        • Desai MY.
        Characteristics and outcomes of patients with aortic stenosis and chronic kidney disease.
        J Am Heart Assoc. 2019; 8e009980
        • Samad Z
        • Sivak JA
        • Phelan M
        • Schulte PJ
        • Patel U
        • Velazquez EJ.
        Prevalence and outcomes of left-sided valvular heart disease associated with chronic kidney disease.
        J Am Heart Assoc. 2017; 6e006044
        • Ternacle J
        • Côté N
        • Krapf L
        • Nguyen A
        • Clavel MA
        • Pibarot P.
        Chronic kidney disease and the pathophysiology of valvular heart disease.
        Can J Cardiol. 2019; 35: 1195-1207
        • Levey AS
        • Coresh J
        • Balk E
        • Kausz AT
        • Levin A
        • Steffes MW
        • Hogg RJ
        • Perrone RD
        • Lau J
        • Eknoyan G
        National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification [published correction appears in Ann Intern Med 2003;139:605].
        Ann Intern Med. 2003; 139: 137-147
        • Dungu JN
        • Valencia O
        • Pinney JH
        • Gibbs SD
        • Rowczenio D
        • Gilbertson JA
        • Lachmann HJ
        • Wechalekar A
        • Gillmore JD
        • Whelan CJ
        • Hawkins PN
        • Anderson LJ.
        CMR-based differentiation of AL and ATTR cardiac amyloidosis.
        JACC Cardiovasc Imaging. 2014; 7: 133-142
        • Ternacle J
        • Krapf L
        • Mohty D
        • Magne J
        • Nguyen A
        • Galat A
        • Gallet R
        • Teiger E
        • Côté N
        • Clavel MA
        • Tournoux F
        • Pibarot P
        • Damy T.
        Aortic stenosis and cardiac amyloidosis: JACC review topic of the week.
        J Am Coll Cardiol. 2019; 74: 2638-2651
        • Cavalcante JL
        • Kusunose K
        • Obuchowski NA
        • Jellis C
        • Griffin BP
        • Flamm SD
        • Kwon DH.
        Prognostic impact of ischemic mitral regurgitation severity and myocardial infarct quantification by cardiovascular magnetic resonance.
        JACC Cardiovasc Imaging. 2020; 13: 1489-1501
        • Kwon DH
        • Hachamovitch R
        • Popovic ZB
        • Starling RC
        • Desai MY
        • Flamm SD
        • Lytle BW
        • Marwick TH.
        Survival in patients with severe ischemic cardiomyopathy undergoing revascularization versus medical therapy: association with end-systolic volume and viability.
        Circulation. 2012; 126: S3-S8
        • Kawel-Boehm N
        • Maceira A
        • Valsangiacomo-Buechel ER
        • Vogel-Claussen J
        • Turkbey EB
        • Williams R
        • Plein S
        • Tee M
        • Eng J
        • Bluemke DA.
        Normal values for cardiovascular magnetic resonance in adults and children.
        J Cardiovasc Magn Reson. 2015; 17: 29
        • Chuang ML
        • Gona P
        • Hautvast GL
        • Salton CJ
        • Breeuwer M
        • O'Donnell CJ
        • Manning WJ
        CMR reference values for left ventricular volumes, mass, and ejection fraction using computer-aided analysis: the Framingham Heart Study.
        J Magn Reson Imaging. 2014; 39: 895-900
        • Kellman P
        • Hansen MS.
        T1-mapping in the heart: accuracy and precision.
        J Cardiovasc Magn Reson. 2014; 16: 2
        • Kellman P
        • Wilson JR
        • Xue H
        • Ugander M
        • Arai AE.
        Extracellular volume fraction mapping in the myocardium, part 1: evaluation of an automated method.
        J Cardiovasc Magn Reson. 2012; 14: 63
        • Aus dem Siepen F
        • Baumgärtner C
        • Müller-Henessen M
        • André F
        • Messroghli D
        • Ochs M
        • Riffel J
        • Giannitsis E
        • Katus HA
        • Friedrich MG
        • Buss SJ
        Variability of cardiovascular magnetic resonance (CMR) T1 mapping parameters in healthy volunteers during long-term follow-up.
        Open Heart. 2018; 5e000717
        • Lang RM
        • Badano LP
        • Mor-Avi V
        • Afilalo J
        • Armstrong A
        • Ernande L
        • Flachskampf FA
        • Foster E
        • Goldstein SA
        • Kuznetsova T
        • Lancellotti P
        • Muraru D
        • Picard MH
        • Rietzschel ER
        • Rudski L
        • Spencer KT
        • Tsang W
        • Voigt JU.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Baumgartner H
        • Hung J
        • Bermejo J
        • Chambers JB
        • Edvardsen T
        • Goldstein S
        • Lancellotti P
        • LeFevre M
        • Miller Jr, F
        • Otto CM.
        Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2017; 30: 372-392
        • Khan MA
        • Yang EY
        • Zhan Y
        • Judd RM
        • Chan W
        • Nabi F
        • Heitner JF
        • Kim RJ
        • Klem I
        • Nagueh SF
        • Shah DJ.
        Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study.
        J Cardiovasc Magn Reson. 2019; 21: 4
        • Généreux P
        • Pibarot P
        • Redfors B
        • Mack MJ
        • Makkar RR
        • Jaber WA
        • Svensson LG
        • Kapadia S
        • Tuzcu EM
        • Thourani VH
        • Babaliaros V
        • Herrmann HC
        • Szeto WY
        • Cohen DJ
        • Lindman BR
        • McAndrew T
        • Alu MC
        • Douglas PS
        • Hahn RT
        • Kodali SK
        • Smith CR
        • Miller DC
        • Webb JG
        • Leon MB.
        Staging classification of aortic stenosis based on the extent of cardiac damage.
        Eur Heart J. 2017; 38: 3351-3358
        • Rusinaru D
        • Bohbot Y
        • Kowalski C
        • Ringle A
        • Maréchaux S
        • Tribouilloy C.
        Left atrial volume and mortality in patients with aortic stenosis.
        J Am Heart Assoc. 2017; 6e006615
        • Hicks KA
        • Tcheng JE
        • Bozkurt B
        • Chaitman BR
        • Cutlip DE
        • Farb A
        • Fonarow GC
        • Jacobs JP
        • Jaff MR
        • Lichtman JH
        • Limacher MC
        • Mahaffey KW
        • Mehran R
        • Nissen SE
        • Smith EE
        • Targum SL
        • American College of Cardiology
        • American Heart Association
        2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in clinical trials: a report of the American College of Cardiology/American Heart Association task force on clinical data standards (writing committee to develop cardiovascular endpoints data standards) [published correction appears in Circulation 2015;132:e129].
        Circulation. 2015; 132: 302-361
        • Ramchand J
        • Patel SK
        • Kearney LG
        • Matalanis G
        • Farouque O
        • Srivastava PM
        • Burrell LM.
        Plasma ACE2 activity predicts mortality in aortic stenosis and is associated with severe myocardial fibrosis.
        JACC Cardiovasc Imaging. 2020; 13: 655-664
      1. The Society of Thoracic Surgeons. Online STS adult cardiac surgery risk calculator 2020. version 2.9. Available at: http://riskcalc.sts.org/stswebriskcalc/#/. Accessed on November 22, 2019.

        • Dass S
        • Suttie JJ
        • Piechnik SK
        • Ferreira VM
        • Holloway CJ
        • Banerjee R
        • Mahmod M
        • Cochlin L
        • Karamitsos TD
        • Robson MD
        • Watkins H
        • Neubauer S.
        Myocardial tissue characterization using magnetic resonance noncontrast t1 mapping in hypertrophic and dilated cardiomyopathy.
        Circ Cardiovasc Imaging. 2012; 5: 726-733
        • Marwick TH
        • Amann K
        • Bangalore S
        • Cavalcante JL
        • Charytan DM
        • Craig JC
        • Gill JS
        • Hlatky MA
        • Jardine AG
        • Landmesser U
        • Newby LK
        • Herzog CA
        • Cheung M
        • Wheeler DC
        • Winkelmayer WC
        • Sarnak MJ
        Conference Participants. Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: improving Global Outcomes (KDIGO) Controversies Conference.
        Kidney Int. 2019; 96: 836-849
        • Adda J
        • Mielot C
        • Giorgi R
        • Cransac F
        • Zirphile X
        • Donal E
        • Sportouch-Dukhan C
        • Réant P
        • Laffitte S
        • Cade S
        • Le Dolley Y
        • Thuny F
        • Touboul N
        • Lavoute C
        • Avierinos JF
        • Lancellotti P
        • Habib G
        Low-flow, low-gradient severe aortic stenosis despite normal ejection fraction is associated with severe left ventricular dysfunction as assessed by speckle-tracking echocardiography: a multicenter study.
        Circ Cardiovasc Imaging. 2012; 5: 27-35