Evaluation of liver parenchymal changes in patients with reduced left ventricular ejection fraction using cardiac MRI T1 mapping and extracellular volume fraction

Abstract Background and Objectives: Congestive hepatopathy (CH) is a diffuse parenchymal liver disease resulting from chronic passive congestion due to cardiac pathology. This retrospective cross-sectional study aims to evaluate hepatic congestion and fibrosis in patients with left ventricular ejection fraction (LVEF) <50% using cardiac magnetic resonance imaging (CMR) T1 mapping and extracellular volume (ECV) fraction. Methods: We analyzed 103 patients with LVEF <50% and 80 controls with normal CMR findings and no prior disease. Regions of interest in the liver parenchyma, interventricular myocardium, and left ventricular blood pool were placed on pre- and post-contrast T1 maps to calculate ECV. Receiver operating characteristic (ROC) analysis assessed the area under the curve (AUC) and optimal cutoff values for predicting reduced LVEF. Spearman’s correlation evaluated associations between T1/ECV values, left ventricular parameters, and biochemical tests. Results: Liver pre-contrast T1 (p<0.001), post-contrast T1 (p=0.032), and ECV (p<0.001) were significantly higher in patients than in controls. Myocardial native T1 (p<0.001) and ECV (p<0.001) were elevated, whereas post-contrast T1 was lower (p=0.012). Liver pre-contrast T1 yielded the highest AUC (0.949) with a cutoff of 608.16 ms (sensitivity 88.3%, specificity 95.0%), outperforming all myocardial and other liver parameters. Native liver T1 correlated with stroke volume index (ρ=-0.461), left ventricular end-diastolic (ρ=0.301) and end-systolic indexes (ρ=0.572), NT-proBNP (ρ=0.324), and GGT (ρ=0.360) (all p<0.001). Conclusions: Routine CMR pre-contrast liver T1 mapping facilitates early detection and quantification of CH in patients with reduced LVEF, potentially preceding overt clinical or laboratory abnormalities.