Paper of the Month

February 2018

Native T1 and ECV of Noninfarcted Myocardium and Outcome in Patients With Coronary Artery Disease. Journal of the American College of Cardiology Feb 2018, 71 (7) 766-778. DZHK authors: Puntmann, Gebker, Kelle, Zitzmann, Herrmann, Zeiher, Nagel

An international consortium, led by Valentina Puntmann from the Institute for Experimental and Translational Cardiovascular Imaging performed a prospective, observational, multicentre outcome study in consecutive 665 patients with known coronary artery disease and a median follow up of 17 months. The findings have now been published in the Journal of the American College of Cardiology (JACC). The researchers demonstrate that characterisation of non-infarcted myocardium by native T1 provides the strongest and independent prediction of survival in these patients, over and above the classical risk stratifiers, including left ventricular ejection fraction (EF), scar and conventional risk scores (p<0.001). This relationship is most accentuated in patients with EF >35% and no or small infarctions. For major cardiac events, native T1 and scar were joint independent predictors, whereas EF and risk score added no prognostic information. These findings provide a basis for novel risk stratification model in patients with coronary artery disease based on a complementary assessment of non-infarcted myocardium with native T1 as well as post-infarction scar and add to questioning the central role of ejection fraction. In addition, the finding demonstrate that the remote myocardium, which was so far regarded as not significantly affected by a myocardial infarction plays a major role in the outcome of these patients.