Hepatic T1-time, cardiac structure and function and cardiovascular outcomes in patients with dilated cardiomyopathy

Riccardo M Inciardi; Marco Merlo; Mariagiulia Bellicini; Martina Setti; Antonio De Luca; Nunzia Di Meo; Paolo Rondi; Matteo Pagnesi; Marianna Adamo; Carlo M Lombardi; Jacopo Giulio Rizzi; Davide Farina; Alessandro Mantovani; Giovanni Targher; Gianfranco Sinagra; Marco Metra; NAFLD-DCM group

doi:10.1016/j.ejim.2024.04.009

Hepatic T1-time, cardiac structure and function and cardiovascular outcomes in patients with dilated cardiomyopathy

Eur J Intern Med. 2024 May 7:S0953-6205(24)00167-5. doi: 10.1016/j.ejim.2024.04.009. Online ahead of print.

Authors

Riccardo M Inciardi¹, Marco Merlo², Mariagiulia Bellicini¹, Martina Setti³, Antonio De Luca⁴, Nunzia Di Meo⁵, Paolo Rondi⁵, Matteo Pagnesi¹, Marianna Adamo¹, Carlo M Lombardi¹, Jacopo Giulio Rizzi², Davide Farina⁵, Alessandro Mantovani⁶, Giovanni Targher⁷, Gianfranco Sinagra², Marco Metra⁸; NAFLD-DCM group

Collaborators

NAFLD-DCM group:
Gianmarco Arabia⁹, Manuela Iseppi¹⁰, Emanuele Gavazzi¹¹, Laura Lupi⁹, Daniela Tomasoni⁹, Enrico Vizzardi⁹

Affiliations

¹ ASST Spedali Civili di Brescia, Division of Cardiology and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
² Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy.
³ Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
⁴ Cardio-Thoraco-Vascular Department, University of Trieste, Trieste, Italy.
⁵ ASST Spedali Civili di Brescia, Division of Radiology and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
⁶ Department of Medicine, University of Verona, Verona, Italy.
⁷ Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella (VR), Italy.
⁸ ASST Spedali Civili di Brescia, Division of Cardiology and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. Electronic address: metramarco@libero.it.
⁹ ASST Spedali  Civili di Brescia, Division of Cardiology and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
¹⁰ Center  for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy.
¹¹ ASST  Spedali Civili di Brescia, Division of Radiology and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

PMID: 38719725
DOI: 10.1016/j.ejim.2024.04.009

Abstract

Aim: Liver damage frequently occurs in patients with cardiovascular (CV) disease and is associated with adverse clinical outcomes. The associations of liver damage with cardiac structure/function measures and the risk of adverse CV events in patients with dilated cardiomyopathy (DCM) are poorly known.

Methods: We retrospectively enrolled consecutive patients with DCM undergoing cardiac magnetic resonance imaging (MRI). In addition to standard cardiac assessment, iron-corrected T1 mapping was also assessed in the liver. Cross-sectional associations between hepatic T1-time and cardiac structure and function were examined accounting for potential confounders. Longitudinal associations between hepatic T1-time and the risk of hospitalization for HF or CV death were also assessed.

Results: Overall, 120 stable patients with established DCM were included in the study (mean age 54.7 years, 26 % women). The mean hepatic iron-corrected T1-time was 563±73 ms. In linear regression analyses, measures of left atrial structure (LA maximal volume, p = 0.035, LA minimal volume=0.012), interventricular septum thickness (p = 0.026), and right ventricular ejection fraction (p = 0.005) were significantly associated with greater hepatic T1-time. Over a mean follow-up of 4.5 ± 1.8 years, 32 (27 %) died or were hospitalized for HF at a rate of 6.7 per 100 person-year. Higher hepatic iron-corrected T1-time was independently associated with a higher risk of adverse events (adjusted-hazard ratio 1.71, 95 % confidence interval: 1.14-2.56, p = 0.009). Patients with a hepatic T1-time ≥563 ms had a higher risk of CV events (log-rank p = 0.03).

Conclusion: Among stable patients with DCM, higher hepatic iron-corrected T1-time is associated with worse cardiac size and function and with higher rates of hospitalization for HF or CV death.

Condensed abstract: Limited data exist regarding the clinical value of hepatic T1-time in patients with dilated cardiomyopathy (DCM) undergoing cardiac Magnetic Resonance imaging (MRI). We found that higher hepatic iron-corrected T1-time is associated with worse cardiac size and function, even after accounting for clinical confounders. Over a mean follow-up of 4.5 ± 1.8 years, higher hepatic iron-corrected T1-time was independently associated with a higher risk of hospitalization for heart failure or cardiovascular death. Among stable patients with DCM, the evaluation of liver tissue by cardiac MRI may provide useful clinical information for CV risk stratification.

Keywords: Dilated cardiomyopathy; Heart Failure; Magnetic resonance imaging.