Huaying Zhang, Wenjing Yang, Di Zhou, Yining Wang, Leyi Zhu, Mengdi Jiang, Qiang Zhang, Arlene Sirajuddin, Andrew E Arai, Shihua Zhao, Minjie Lu
{"title":"心肌T1定位和细胞外体积分数在心力衰竭中的预后价值：一项荟萃分析。","authors":"Huaying Zhang, Wenjing Yang, Di Zhou, Yining Wang, Leyi Zhu, Mengdi Jiang, Qiang Zhang, Arlene Sirajuddin, Andrew E Arai, Shihua Zhao, Minjie Lu","doi":"10.1016/j.jcmg.2025.06.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a global health burden. Myocardial fibrosis is a crucial promotor in HF progression which can be characterized noninvasively by cardiac magnetic resonance T1 mapping.</p><p><strong>Objectives: </strong>This study aims to systemically evaluate the prognostic value of myocardial T1 mapping and extracellular volume fraction (ECV) covering the entire spectrum of HF through a meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, and SCOPUS for studies examining the prognostic value of T1 mapping in HF with reduced and preserved ejection fraction. Baseline level, mean difference, and HRs were pooled for meta-analysis. Subgroup analyses were conducted according to HF subtypes and clinical characteristics.</p><p><strong>Results: </strong>Nineteen studies with 5,384 patients (56.2% male) were included in the analysis. Patients with adverse outcomes (mortality, HF-related event, or composite outcome) had higher native T1 and ECV values than those without (weighted mean difference: 41.17 ms and 4.73%, respectively). Both native T1 and ECV were positively associated with endpoints for the entire HF group (HR of 1% increase in ECV: 1.20 [95% CI: 1.13-1.28]; HR of >1% increase: 1.56 [95% CI: 1.40-1.75]; HR binary: 2.62 [95% CI: 2.07-3.32]; HR of 1-ms increase in native T1: 1.02 [95% CI: 1.01-1.03]; HR of ≥10-ms increase: 1.08 [95% CI: 1.05-1.11]; HR binary: 2.93 [95% CI: 2.03-4.23], all P < 0.05). For subgroup cohorts, native T1 had no significant prognostic value in HF with preserved ejection fraction (P > 0.05). Younger patients with HF with severe cardiac insufficiency (NYHA functional class III-IV), persistently increasing ECV, or negative late enhancement who exhibited abnormal T1 mapping were at higher risk of adverse outcomes.</p><p><strong>Conclusions: </strong>ECV has consistent prognostic implications across HF spectrum, regardless of HF types, clinical characteristics, and various etiology. Native T1 is less predictive than ECV, particularly in HF with preserved ejection fraction.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":15.2000,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic Value of Myocardial T1 Mapping and Extracellular Volume Fraction in Heart Failure: A Meta-Analysis.\",\"authors\":\"Huaying Zhang, Wenjing Yang, Di Zhou, Yining Wang, Leyi Zhu, Mengdi Jiang, Qiang Zhang, Arlene Sirajuddin, Andrew E Arai, Shihua Zhao, Minjie Lu\",\"doi\":\"10.1016/j.jcmg.2025.06.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Heart failure (HF) is a global health burden. Myocardial fibrosis is a crucial promotor in HF progression which can be characterized noninvasively by cardiac magnetic resonance T1 mapping.</p><p><strong>Objectives: </strong>This study aims to systemically evaluate the prognostic value of myocardial T1 mapping and extracellular volume fraction (ECV) covering the entire spectrum of HF through a meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, and SCOPUS for studies examining the prognostic value of T1 mapping in HF with reduced and preserved ejection fraction. Baseline level, mean difference, and HRs were pooled for meta-analysis. Subgroup analyses were conducted according to HF subtypes and clinical characteristics.</p><p><strong>Results: </strong>Nineteen studies with 5,384 patients (56.2% male) were included in the analysis. Patients with adverse outcomes (mortality, HF-related event, or composite outcome) had higher native T1 and ECV values than those without (weighted mean difference: 41.17 ms and 4.73%, respectively). Both native T1 and ECV were positively associated with endpoints for the entire HF group (HR of 1% increase in ECV: 1.20 [95% CI: 1.13-1.28]; HR of >1% increase: 1.56 [95% CI: 1.40-1.75]; HR binary: 2.62 [95% CI: 2.07-3.32]; HR of 1-ms increase in native T1: 1.02 [95% CI: 1.01-1.03]; HR of ≥10-ms increase: 1.08 [95% CI: 1.05-1.11]; HR binary: 2.93 [95% CI: 2.03-4.23], all P < 0.05). For subgroup cohorts, native T1 had no significant prognostic value in HF with preserved ejection fraction (P > 0.05). Younger patients with HF with severe cardiac insufficiency (NYHA functional class III-IV), persistently increasing ECV, or negative late enhancement who exhibited abnormal T1 mapping were at higher risk of adverse outcomes.</p><p><strong>Conclusions: </strong>ECV has consistent prognostic implications across HF spectrum, regardless of HF types, clinical characteristics, and various etiology. Native T1 is less predictive than ECV, particularly in HF with preserved ejection fraction.</p>\",\"PeriodicalId\":14767,\"journal\":{\"name\":\"JACC. Cardiovascular imaging\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":15.2000,\"publicationDate\":\"2025-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. 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Prognostic Value of Myocardial T1 Mapping and Extracellular Volume Fraction in Heart Failure: A Meta-Analysis.
Background: Heart failure (HF) is a global health burden. Myocardial fibrosis is a crucial promotor in HF progression which can be characterized noninvasively by cardiac magnetic resonance T1 mapping.
Objectives: This study aims to systemically evaluate the prognostic value of myocardial T1 mapping and extracellular volume fraction (ECV) covering the entire spectrum of HF through a meta-analysis.
Methods: We searched PubMed, Web of Science, and SCOPUS for studies examining the prognostic value of T1 mapping in HF with reduced and preserved ejection fraction. Baseline level, mean difference, and HRs were pooled for meta-analysis. Subgroup analyses were conducted according to HF subtypes and clinical characteristics.
Results: Nineteen studies with 5,384 patients (56.2% male) were included in the analysis. Patients with adverse outcomes (mortality, HF-related event, or composite outcome) had higher native T1 and ECV values than those without (weighted mean difference: 41.17 ms and 4.73%, respectively). Both native T1 and ECV were positively associated with endpoints for the entire HF group (HR of 1% increase in ECV: 1.20 [95% CI: 1.13-1.28]; HR of >1% increase: 1.56 [95% CI: 1.40-1.75]; HR binary: 2.62 [95% CI: 2.07-3.32]; HR of 1-ms increase in native T1: 1.02 [95% CI: 1.01-1.03]; HR of ≥10-ms increase: 1.08 [95% CI: 1.05-1.11]; HR binary: 2.93 [95% CI: 2.03-4.23], all P < 0.05). For subgroup cohorts, native T1 had no significant prognostic value in HF with preserved ejection fraction (P > 0.05). Younger patients with HF with severe cardiac insufficiency (NYHA functional class III-IV), persistently increasing ECV, or negative late enhancement who exhibited abnormal T1 mapping were at higher risk of adverse outcomes.
Conclusions: ECV has consistent prognostic implications across HF spectrum, regardless of HF types, clinical characteristics, and various etiology. Native T1 is less predictive than ECV, particularly in HF with preserved ejection fraction.
期刊介绍：
JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography.
JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy.
In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.
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