Evaluation of clinical and imaging factors of native T1 values in patients with stable coronary artery disease

Introduction: Stable coronary artery disease (CAD) is a leading cause of cardiac morbidity and mortality worldwide, with elevated native T1 value linked to major adverse cardiovascular events. However, predictors of elevated native T1 value in stable CAD still need to be studied. This study aimed to identify clinical and imaging predictors of elevated native T1 values in CAD patients. Methods: A total of 316 consecutive stable CAD patients (median age 58 years, 91.8% male) undergoing coronary computed tomography angiography and cardiovascular magnetic resonance native T1 mapping were included, along with 30 age- and sex-matched healthy controls. Patients were divided into normal and elevated native T1 groups based on the normal global native T1 reference; logistic regressions were used to identify predictors. Results: Patients with elevated native T1 values were more likely to be aged ≥60 years, abstain from alcohol, have abnormal electrocardiogram findings, multivessel disease, noncalcified plaques, greater degrees of stenosis, stenosis ≥50% in two or three coronary arteries, and computed tomography-derived fractional flow reserve ≤0.8 (p < 0.05). Multivariate logistic regression identified age ≥60 years (odd ratio [OR]: 2.23, 95% confidence interval [95% CI]: 1.15–4.30, p = 0.018), stenosis ≥50% in two (OR: 13.27, 95% CI: 3.38–56.94, p < 0.001) or three coronary arteries (OR: 114.19, 95% CI: 20.53–276.59, p < 0.001), and left anterior descending FFR ≤0.8 (OR: 2.69, 95% CI: 1.16–6.29, p = 0.021) as independent risk factors, whereas alcohol consumption (OR: 0.47, 95% CI: 0.25–0.88, p = 0.019) was a predictor of normal native T1 values, with strong predictive performance (area under the curve = 0.832, Brier score = 0.142). Conclusion: Our findings could help clinicians make individualized diagnosis and treatment of stable CAD patients, which also provide a foundation for predicting prognosis. This research has been registered in the National Medical Research Registration and Filing Information System, numbered MR-32-24-030226.