T1 Mapping in Pulmonary Hypertension: A Novel Tool for Risk Stratification in Patients with Left Ventricular Dysfunction (RF_TH_269)

Thursday, January 30, 2025

6:10 PM – 6:20 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

AA

Arif Albulushi, MD

Assistant Professor and Consultant
National Heart Center, The Royal Hospital, Oman

Primary Author(s)

AA

Arif Albulushi, MD

Assistant Professor and Consultant
National Heart Center, The Royal Hospital, Oman

Co-Author(s)

KA

Kamla Al-Wahaibi, MD

Consultant
National Heart Center, The Royal Hospital, Oman

Background: Pulmonary hypertension (PH) in patients with left ventricular dysfunction (LVD) is associated with poor outcomes, but current risk stratification methods are limited. Cardiac magnetic resonance (CMR) T1 mapping is a non-invasive tool for quantifying diffuse myocardial fibrosis, potentially providing a more accurate means of risk stratification. This study explores the role of T1 mapping as a prognostic tool in PH patients with LVD across different severity levels of PH

Methods:

We conducted a prospective, multicenter study involving 110 patients with LVD and PH, classified into mild (n=40), moderate (n=38), and severe (n=32) PH based on right heart catheterization. Each patient underwent CMR, including native T1 mapping, at baseline. T1 values were measured in the left ventricular myocardium, and correlations with clinical outcomes (hospitalizations, functional status, and mortality) were analyzed over a 24-month follow-up period.

Results: Elevated T1 values were strongly correlated with increasing PH severity Table 1. Patients with mild PH had a mean T1 value of 1010 ms, while those with moderate and severe PH had mean values of 1100 ms and 1205 ms, respectively. Higher T1 values were predictive of worse clinical outcomes. In the severe PH group, 68% of patients were hospitalized, and 45% experienced mortality, compared to 12% hospitalization and 4% mortality in the mild PH group. Multivariate analysis showed that T1 values were an independent predictor of adverse events, outperforming traditional markers such as right ventricular ejection fraction (RVEF) and pulmonary vascular resistance (PVR) Figure 1

Conclusion:

T1 mapping offers a novel approach for risk stratification in PH patients with LVD, providing early identification of high-risk patients. This technique could be incorporated into routine CMR assessments to improve clinical decision-making and patient outcomes. Future studies should explore the utility of T1 mapping in broader populations and different PH subtypes.