Association between CMR-derived hepatic T1-time, tricuspid regurgitation and survival

Background: Cardiac magnetic resonance (CMR) derived hepatic T1-time is associated with outcome. However, the interplay between tricuspid regurgitation (TR), which can cause congestive hepatopathy and liver T1-time is unclear. Methods: We measured hepatic T1-time in CMR all-comers, who underwent echocardiography within 3 weeks of CMR. Kaplan–Meier estimates and Cox regression models were used to investigate the association between hepatic T1-time, TR severity and a composite endpoint of heart failure hospitalisation and all-cause death. Results: 1029 participants (67 ± 17 y/o, 44% female) had a mean hepatic T1-time of 605 ± 79 ms. Overall, 41% (417) presented with non/trace, 38% (391) with mild, 13% (135) with moderate and 8% (85) with severe/massive/torrential TR. Liver T1-time was significantly associated with TR severity (no/trace: 586 ± 72 ms; mild: 601 ± 74 ms; moderate: 634 ± 84 ms; severe/massive/torrential: 665 ± 83 ms; β = 25.4 ms, [95% CI:19.7–31.2, p <.001]). After adjustment for serum NT-proBNP and right ventricular function in a linear regression model, TR severity remained significantly associated with hepatic T1-time (p <.001). During follow-up (mean 53 ± 36 months) 326 (32%) events occurred. Hepatic T1-time (adj.HR 1.69 [95% CI: 1.49–1.92] per 100 ms increase, p <.001) and TR (adj.HR 1.66 [95% CI: 1.49–1.84], p <.001) were both associated with outcome. Even after adjustment for serum NT-proBNP, cardiac structure and function, age, sex and TR severity, hepatic T1-time remained significantly associated with event-free survival (adj.HR 1.42 [95% CI: 1.20–1.68] per 100 ms increase, p <.001). Conclusion: TR exerts a notable influence on hepatic T1-time. Nevertheless, after adjustment for serum NTproBNP, cardiac function and TR severity, hepatic T1-time still independently predicts outcomes. This underscores the importance of hepatic T1-time both as a marker of TR and prognosis.