Hepatic t1 mapping: a new easily obtained biomarker for heart failure patients undergoing cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hepatic venous pressure overload and subsequent liver damage are frequent in patients with Chronic Heart Failure (CHF) but are difficult to quantify except in the late stages of disease. Myocardial T1 mapping is now commonly performed in patients undergoing cardiac magnetic resonance (CMR), with short axis images usually intercepting the liver, therefore allowing the opportunistic measurement of hepatic T1 values. Purpose The aim of this study was to quantify hepatic T1 values in HF patients undergoing CMR, and to assess its clinical and prognostic significance as a biomarker in this setting. Methods Consecutive patients with CHF (LVEF ≤ 50%) who underwent CMR at a single centre since Jan2019 were retrospectively identified. Those with known chronic liver disease, cardiac amyloidosis or suspected alcoholic cardiomyopathy were excluded. Native myocardial T1 mapping [MOLLI 5(3)3 sequence] basal short axis images were used to measure hepatic T1, with the region of interest drawn in the liver, avoiding organ vessels. A control group of subjects without known cardiovascular disease (n=57) was used to define the limits of normality for hepatic T1 values. The clinical significance of hepatic T1 values was assessed by its relationship with markers of right-sided CHF, and its prognostic value by the association with cardiovascular mortality. Results A total of 267 patients (mean age 62±15 years, 69% men, 38% with ischemic cardiomyopathy) were included. Median LVEF was 35% (IQR 26 – 44%) and median RVEF was 51% (IQR 40 – 59%). Overall, 46 patients (17%) had hepatic T1 values above 684 ms (the upper limit of normal for controls). Patients with elevated hepatic T1 had significantly higher RV volumes and lower RVEF (all p values <0.03). Hepatic T1 values were significantly higher in patients with RVEF<45% and in those with moderate or severe tricuspid regurgitation (Figure 1), and were also inversely correlated with RVEF (Spearman R −0.20, p<0.001). During a median follow-up period of 17 months (IQR 11–24), there were 11 cardiovascular deaths. Elevated hepatic T1 was associated with an increased risk of this endpoint (HR 3.04, 95%CI 1.02 – 9.11, p = 0.047). Conclusions Hepatic T1 values can be easily measured in standard myocardial T1 maps, are associated with markers of right-sided heart failure, and have prognostic value in patients with HF. Further studies are warranted to assess the potential clinical usefulness of this new biomarker.