scholarly journals Myocardial native T1 mapping and correlations with clinical and CMR parameters in patients with systemic sclerosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Meloni ◽  
L Gargani ◽  
C Bruni ◽  
C Cavallaro ◽  
M Gobbo ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Myocardial Fibrosis ◽  
Healthy Subjects ◽  
T1 Mapping ◽  
Cardiac Involvement ◽  
Left Ventricular ◽  
Volume Index ◽  
Imaging Protocol ◽  
Native T1 ◽  
Spin Echo Sequence

Abstract Funding Acknowledgements Type of funding sources: None. Background Systemic sclerosis (SSc) is a connective tissue disease characterized by diffuse vascular lesions and fibrosis, also affecting the heart. Cardiovascular magnetic resonance (CMR) can detect replacement myocardial fibrosis by late gadolinium enhancement (LGE) and interstitial myocardial fibrosis/edema by T1 mapping techniques. Purpose To evaluate the prevalence of cardiac involvement by native T1 mapping and its correlation with clinical and CMR parameters in SSc patients. Methods Fifty-one consecutive SSc patients (mean age 51.8 ± 13.7 years, 42 females) and 51 healthy subjects matched for age and sex underwent clinical, bio-humoral assessment, and CMR at 1.5T (Signa Artist, GE Healthcare ). The imaging protocol included: cine, T1 mapping by MOLLI, T2 mapping by multi-echo fast-spin-echo sequence, LGE, and STIR T2-weighted sequences. Native T1 and T2 values were assessed in all 16 myocardial segments and the global value was the mean. Results. Global native T1 values were significantly higher in SSc patients than in healthy subjects (1076.4 ± 50.7 vs 1033.3 ± 31.9 ms; P < 0.0001). As in healthy subjects, in patients native T1 values were significantly lower in males than in females (1033.4 ± 38.3 vs 1085.6 ± 48.6 ms; P = 0.004) and inversely correlated with age (R=-0415; P = 0.002). Twenty-three (45.1%) patients had an increased global heart T1 value (>1060 ms in males and >1085 ms in females). Of them, 14 patients (60.9 %) showed positive LGE. Frequency of cardiovascular risk factors, indices of disease activity and chronicity, biochemical parameters, and cardio-active therapy were comparable between patients with normal and elevated T1. Compared to patients with normal T1 value, patients with elevated T1 had significantly higher left ventricular (LV) end-diastolic volume index (76.8 ± 13.3 vs 69.2 ± 11.8, P = 0.050), LV stroke volume index (49.7 ± 6.4 vs 44.4 ± 6.9 ml/m2; P = 0.010), LV cardiac output (3.6 ± 0.5  vs 3.0 ± 0.6 l/min /m2; P < 0.0001), and global heart T2 values (60.1 ± 3.6 vs 55.7 ± 3.1 ms; P < 0.0001). Replacement myocardial fibrosis was detected in 24 (47.1%) patients and they showed significantly higher global heart native T1 values (Figure 1A). Positive T2-weighted images for myocardial oedema were found in 5 (9.8%) patients, all with increased global heart native T1 value. Patients with oedema had significantly higher native global heart T1 values (Figure 1B). Conclusion Elevated native T1 values measured by CMR are frequent in SSc patients and they are associated with inflammation, replacement fibrosis, and increased LV dimension. CMR T1 mapping seems to be a sensitive parameter to include in the routine clinical assessment of SSc patients for detecting earlier pejorative cardiac involvement, although prospective data are recommended. Abstract Figure.

scholarly journals Cardiovascular magnetic resonance-determined left ventricular myocardium impairment is associated with C-reactive protein and ST2 in patients with paroxysmal atrial fibrillation

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Lei Zhao ◽  
Songnan Li ◽  
Chen Zhang ◽  
Jie Tian ◽  
Aijia Lu ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Healthy Subjects ◽  
T1 Mapping ◽  
Circumferential Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Healthy Controls ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Native T1

Abstract Background Myocardial strain assessed with cardiovascular magnetic resonance (CMR) feature tracking can detect early left ventricular (LV) myocardial deformation quantitatively in patients with a variety of cardiovascular diseases, but this method has not yet been applied to quantify myocardial strain in patients with atrial fibrillation (AF) and no coexistent cardiovascular disease, i.e., the early stage of AF. This study sought to compare LV myocardial strain and T1 mapping indices in AF patients and healthy subjects, and to investigate the associations of a portfolio of inflammation, cardiac remodeling and fibrosis biomarkers with LV myocardial strain and T1 mapping indices in AF patients with no coexistent cardiovascular disease. Methods The study consisted of 80 patients with paroxysmal AF patients and no coexistent cardiovascular disease and 20 age- and sex-matched healthy controls. Left atrial volume (LAV), LV myocardial strain and native T1 were assessed with CMR, and compared between the AF patients and healthy subjects. Biomarkers of C-reactive protein (CRP), transforming growth factor beta-1 (TGF-β1), collagen III N-terminal propeptide (PIIINP), and soluble suppression of tumorigenicity 2 (sST2) were obtained with blood tests, and compared between the AF patients and healthy controls. Associations of these biomarkers with those CMR-measured parameters were analyzed for the AF patients. Results For the CMR-measured parameters, the AF patients showed significantly larger LAV and LV end-systolic volume, and higher native T1 than the healthy controls (max P = 0.027). The absolute values of the LV peak systolic circumferential strain and its rate as well as the LV diastolic circumferential strain rate were all significantly reduced in the AF patients (all P < 0.001). For the biomarkers, the AF patients showed significantly larger CRP (an inflammation biomarker) and sST2 (a myocardium stiffness biomarker) than the controls (max P = 0.007). In the AF patients, the five CMR-measured parameters of LAV, three LV strain indices and native T1 were all significantly associated with these two biomarkers of CRP and sST2 (max P = 0.020). Conclusions In patients with paroxysmal AF and no coexistent cardiovascular disease, LAV enlargement and LV myocardium abnormalities were detected by CMR, and these abnormalities were associated with biomarkers that reflect inflammation and myocardial stiffness.

scholarly journals Association between Native Myocardial T1 Mapping and Cardiac Function and Macroscopic Fibrosis in Thalassemia Major

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Alessia Pepe ◽  
Nicola Martini ◽  
Antonio De Luca ◽  
Vincenzo Positano ◽  
Laura Pistoia ◽  
...  
Keyword(s):  
Iron Overload ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Lv Function ◽  
Myocardial Iron ◽  
Native T1 ◽  
Molli Sequence ◽  
Lv Volume

Background.Cardiovascular magnetic resonance (CMR) is the only available technique for the non-invasive quantification of MIO. The native T1 mapping has recently been proposed as an alternative to the universally adopted T2* technique, due to the higher sensitivity for detection of changes associated with mild or early iron overload. Objective.To study the association between T1 values and left ventricular (LV) function in thalassemia major (TM) and to evaluate for the first time if T1 measurements quantifying MIO are influenced by macroscopic myocardial fibrosis. Methods.146 TM patients (87 females, 38.7±11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network underwent CMR. Native T1 values were obtained by Modified Look-Locker Inversion recovery (MOLLI) sequence in all 16 myocardial segments and the global value was the mean. LV function parameters were quantified by cine images. Late gadolinium enhancement (LGE) technique was used to detect macroscopic myocardial fibrosis. Results.No correlation was detected between global heart T1 values and LV volume indexes, LV mass index, or LV ejection fraction. Foourteen (9.6%) patients had an abnormal LV motion (13 hypokinesia and 1 dyskinesia) and they showed significantly lower global heart T1 values than patients without LV motion abnormalities (883.8±139.7 ms vs 959.0±91.3 ms; P=0.049). LGE images were acquired in 88 patients (60.3%) and macroscopic myocardial fibrosis was detected in 36 patients (40.9%). The 72.2% of patients had two or more foci of fibrosis. Patients with macroscopic myocardial fibrosis had significantly lower global heart T1 values (921.3±100.3 ms vs 974.5±72.7 ms; P=0.027) (Figure 1A). Data about the LGE was present for 1408 segments (88 patients x 16 segments) and 105 (7.5%) were positive. Segments with LGE had significantly lower T1 values than segments LGE-negative (905.6±110.6 ms vs 956.9±103.8 ms; P&lt;0.0001) (Figure 1B). Conclusion.No correlation between T1 values and LV function parameters was detected, probably because the majority of the patients had normal or mild abnormal LV parameters. TM patients with macroscopic myocardial fibrosis showed significantly lower T1 values suggesting that T1 measurements for quantifying MIO are not influenced by macroscopic myocardial fibrosis and an association between myocardial iron and macroscopic fibrosis, previously detected only in pediatric TM patients. Figure Disclosures Pepe: Chiesi Farmaceutici S.p.A.:Other: no profit support and speakers' honoraria;Bayer:Other: no profit support;ApoPharma Inc.:Other: no profit support.Pistoia:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.Meloni:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.

P1254CARDIAC TISSUE CHARACTERISATION AND AUTONOMIC FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ON HAEMODIALYSIS: A PILOT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mia Cokljat ◽  
Nicholas Bunce ◽  
Taigang He ◽  
Debasish Banerjee
Keyword(s):  
Myocardial Fibrosis ◽  
T2 Mapping ◽  
Left Ventricular ◽  
Volume Index ◽  
Healthy Controls ◽  
Systolic Volume ◽  
Native T1 ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Provocation Testing

Abstract Background and Aims Sudden cardiac death rates are higher in patients with CKD and on haemodialysis. Hypotheses include the presence of diffuse myocardial fibrosis secondary to fluid and toxin overload. Native T1, T2 and T2* mapping through cardiac magnetic resonance (CMR) is emerging as a novel technique to quantify myocardial fibrosis. This pilot study aimed to quantify cardiac morphological change using CMR native T1, T2 and T2* mapping and correlate with autonomic provocation testing, in CKD 3b-5 and haemodialysis patients. Method Patients with stable CKD 3b and higher, and patients on haemodialysis (CKD-haemodilaysis) underwent a non-contrast CMR, which included native T1, T2, T2* mapping. Autonomic provocation testing was performed using a dipolar ECG lead, followed by 14-days of recording. Results were compared between patient groups, and T1, T2, T2* maps compared to healthy controls using the student t test and Kruskal-Wallis tests. Results Nine CKD, eight haemodialysis and seven control patients were recruited (Table 1). Of the late-stage CKD patients, three were stage 3b, four were stage 4 and two were stage 5. There were no significant differences between the two patient groups in baseline characteristics (Table 1). There were no significant differences between CKD and CKD-haemodialysis patients in left ventricular end-diastolic volume index, left ventricular end-systolic volume index, right ventricular end-diastolic volume index, right ventricular end-systolic volume index, ejection fraction, and left ventricular mass index (71.1±15.2 vs. 80.51 ±21.9 ml/m2, p=0.316; 24.4±7.09 vs. 34.4±19.4 ml/m2, p=0.171; 67.11 ± 14.9 vs. 75.5±23.4 ml/m2, p=0.386; 22.2±4.87 vs. 23.9±9.93 ml/m2, p=0.663; 65.8±6.34 vs. 59.5±12.4 %, p=0.200; 48.4±8.60 vs. 50.5±11.0 g/m2, p=0.673). T1 and T2 were significantly increased in CKD and CKD-haemodialysis patients compared to healthy controls (1259±57.7 vs. 1204±22.3 ms, p=0.038 and 49.1±4.74 vs. 42.0±2.79 ms, p=0.034). There was no difference in T2* star (32.8±7.59 vs. 28.8±3.77, p=0.291). There was no significant difference in native T1, T2 and T2* times between CKD and CKD-haemodialysis patients (1247±66.7 vs. 1273±45.7, p=0.361; 49.1±5.22 vs. 49.0±4.49, p=0.960; 34.1±7.57 vs. 31.3±7.81, p=0.769). Mean percentage change of HR in CKD patients from lying to sitting to standing was 4.51%±6.66 and 11.5%±11.8 respectively. Mean percentage change of HR in CKD-haemodialysis from lying to sitting to standing was 2.15%±6.30 and 6.0%±4.45 respectively. There were no significant differences in postural HR variability between CKD and CKD-haemodialysis patients (p=0.478 and p=0.237). Conclusion In late stage CKD, cardiac volumes, mass, ejection fraction and native T1, T2 and T2* are comparable to those of patients on long-term haemodialysis. However native T1 and T2 times are significantly elevated in later stage CKD and haemodialysis, compared to healthy controls. Heart rate changes over postural provocation are comparable between CKD and CKD-haemodialysis patients, although autonomic response is reduced compared to previously published data in healthy controls. Processes that drive myocardial fibrosis may start earlier in CKD pathogenesis.

scholarly journals Cardiac magnetic resonance parametric mapping can detect early cardiac involvement of patients with systemic sclerosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Purevsuren ◽  
M Uehara ◽  
M Ishizuka ◽  
T Hara ◽  
N Kakuda ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Cardiac Involvement ◽  
Ventricular Septum ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Parametric Mapping ◽  
Native T1 ◽  
Left And Right ◽  
Right Atrial Volume

Abstract Background Systemic sclerosis (SSc) is divided into two subtypes, diffuse and limited cutaneous SSc (dcSSc and lcSSc). The dcSSc subtype has more severe internal organ fibrosis than lcSSc. It is unclear whether cardiovascular magnetic resonance (CMR) parametric mapping can detect early cardiac involvement in these two subtypes. Purpose To detect cardiac involvement and evaluate differences between the two subtypes, we examined CMR parametric mapping. Methods 57 consecutive SSc patients (27 dcSSc and 30 lcSSc) who visited our hospital from July 2018 to February 2021 and underwent CMR at 3.0T (Philips) were included. We analyzed myocardial damage using CMR parametric mapping and compared it with clinical data. Results Mean disease durations of dcSSc and lcSSc were 4.0±6.5 years and 4.4±8.3 years, respectively. Although there were no significant differences in LVEF (56.8±8.8 vs 59.6±7.2), the left and right atrial volume index were significantly larger in dcSSc compared with lcSSc (all p&lt;0.05). Focal fibrosis as evaluated by late gadolinium enhancement was found in 9 SSc patients (15.7%) and 4 patients had pulmonary hypertension. DcSSc patients had significantly higher mid-ventricular native T1 (1350.8±73.2 vs 1312.9±52.1, p=0.029) and postcontrast T1 values (640.4±59.4 vs 604.6±42.5, p=0.015) as compared to lcSSc, although there were no significant differences in ECV and T2 values. Native T1 values in mid-ventricular septum were positively correlated with E/e' ratio of echocardiography in overall SSc patients and dcSSc patients but not in lcSSc patients (r=0.320, p=0.021; r=0.505, p=0.010; r=0.195, p=0.329). Native T1 values in mid-ventricular septum were also positively correlated with plasma levels of brain natriuretic peptide (BNP) in overall SSc patients and dcSSc patients but not in lcSSc patients (r=0.353, p=0.008; r=0.484, p=0.011; r=0.113, p=0.559).The multiple regression analysis considering age and sex revealed that mid-ventricular septum native T1 was the independent predictor of E/e' in SSc patients (β=0.306, p=0.026), and dcSSc patients (β=0.553, p=0.007) but not in lcSSc patients (β=−0.282, p=0.105). The ROC curve for predicting E/e'≥14, cut-off value of native T1 in mid-ventricular septum was ≥1348.5msec (AUC 0.762; 95% CI 0.571–0.953; sensitivity 80.0%; specificity 68.1%). BNP was significantly higher in patients with native T1≥1348.5 msec compared with native T1&lt;1348.5 (102.8±112.8 vs 45.7±55.7; p=0.014). The interobserver variability of CMR parametric mapping values was excellent in this study. Conclusion DcSSc patients showed higher native T1 and larger left and right atrial volume index of CMR than lcSSc patients, suggesting that DcSSc patients had more severe myocardial involvement and left ventricular diastolic dysfunction than lcSSc patients. Early detection of the high native T1 may predict the occurrence of cardiovascular events in the future. FUNDunding Acknowledgement Type of funding sources: None. Correlation between native T1 and BNP Correlation between native T1 and E/e'

scholarly journals Assessment of Cardiac Involvement in Fabry Disease (FD) with Native T1 Mapping

2019 ◽  
Vol 191 (10) ◽  
pp. 932-939
Author(s):  
Fritz Christian Roller ◽  
Sven Fuest ◽  
Marco Meyer ◽  
Sebastian Harth ◽  
Dursun Gündüz ◽  
...  
Keyword(s):  
Fabry Disease ◽  
T1 Mapping ◽  
Cardiac Involvement ◽  
Morphological Changes ◽  
Tissue Level ◽  
Therapeutic Benefit ◽  
Left Ventricular ◽  
Imaging Biomarker ◽  
Native T1 ◽  
Native T1 Time

Purpose Fabry disease (FD) is an X-linked multi-organ disorder of lysosomal metabolism with cardiac disease being the leading cause of death. Identifying early FD-specific pathologies is important in the context of maximum therapeutic benefit in these stages. Therefore, the aim of this study was to investigate the value of quantitative cardiac T1 mapping as a potential disease-specific surrogate. Methods 16 consecutive FD patients (9 female, 7 male; median age: 54 years, IQR 17) and 16 control patients (9 female, 7 male; median age: 52 years, IQR 20) were investigated at 1.5 Tesla. Native T1 mapping was performed using a modified look locker inversion recovery sequence (MOLLI) and native T1 times were measured within the septal myocardium at the midventricular short-axis section. Also functional parameters, left ventricular morphology, presence of late-gadolinium enhancement, cTnI- and Lyso-Gb3-Levels were evaluated. Results The median native septal T1 time for FD was 889.0 ms and 950.6 ms for controls (p < 0.003). LGE and positive cTnI values (0.26 ± 0.21) were present in 5 FD patients (31.25 %), and left ventricular hypertrophy (LVH) was present in 4 FD patients (25.00 %). The 4 cTnI and 8 Lyso-Gb3 positive FD patients had significantly lower native T1 values (p < 0.05, respectively p < 0.01). Assuming a T1 cut-off value of 900 ms for the identification of increased cardiac lipid deposit, 9 patients with FD (56.25 %) had pathologic values (4 patients cTnI and 8 patients Lyso-Gb3 positive). Moreover, native septal T1 showed a good negative correlation to Lyso-Gb3 (r = – 0.582; p = 0.018). Conclusion A pathologic cardiac native T1 time obviously reflects cardiac involvement in the scope of FD at tissue level. In the future native T1 mapping as an imaging biomarker might allow identification of early stages of cardiac involvement in FD before morphological changes are obvious. Key Points:  Citation Format

scholarly journals Myocardial T1-mapping for early detection of left ventricular myocardial fibrosis in systemic sclerosis

2011 ◽  
Vol 13 (S1) ◽  
Author(s):  
Franck Thuny ◽  
Leila Potton ◽  
Stanislas Rapacchi ◽  
Hélène Thibault ◽  
Cyrille Bergerot ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Early Detection ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Myocardial T1

scholarly journals Non-contrast cardiovascular magnetic resonance detection of myocardial fibrosis in Duchenne muscular dystrophy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Frank J. Raucci ◽  
Meng Xu ◽  
Kristen George-Durrett ◽  
Kimberly Crum ◽  
James C. Slaughter ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Duchenne Muscular Dystrophy ◽  
Magnetic Resonance ◽  
Muscular Dystrophy ◽  
Myocardial Fibrosis ◽  
Severity Score ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Native T1

Abstract Background Duchenne muscular dystrophy (DMD) leads to progressive cardiomyopathy. Detection of myocardial fibrosis with late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) is critical for clinical management. Due to concerns of brain deposition of gadolinium, non-contrast methods for detecting and monitoring myocardial fibrosis would be beneficial. Objectives We hypothesized that native T1 mapping and/or circumferential (εcc) and longitudinal (εls) strain can detect myocardial fibrosis. Methods 156 CMRs with gadolinium were performed in 66 DMD boys and included: (1) left ventricular ejection fraction (LVEF), (2) LGE, (3) native T1 mapping and myocardial tagging (εcc-tag measured using harmonic phase analysis). LGE was graded as: (1) presence/absence by segment, slice, and globally; (2) global severity from 0 (no LGE) to 4 (severe); (3) percent LGE using full width half maximum (FWHM). εls and εcc measured using feature tracking. Regression models to predict LGE included native T1 and either εcc-tag or εls and εcc measured at each segment, slice, and globally. Results Mean age and LVEF at first CMR were 14 years and 54%, respectively. Global εls and εcc strongly predicted presence or absence of LGE (OR 2.6 [1.1, 6.0], p = 0.029, and OR 2.3 [1.0, 5.1], p = 0.049, respectively) while global native T1 did not. Global εcc, εls, and native T1 predicted global severity score (OR 2.6 [1.4, 4.8], p = 0.002, OR 2.6 [1.4, 6.0], p = 0.002, and OR 1.8 [1.1, 3.1], p = 0.025, respectively). εls correlated with change in LGE by severity score (n = 33, 3.8 [1.0, 14.2], p = 0.048) and εcc-tag correlated with change in percent LGE by FWHM (n = 34, OR 0.2 [0.1, 0.9], p = 0.01). Conclusions Pre-contrast sequences predict presence and severity of LGE, with εls and εcc being more predictive in most models, but there was not an observable advantage over using LVEF as a predictor. Change in LGE was predicted by εls (global severity score) and εcc-tag (FWHM). While statistically significant, our results suggest these sequences are currently not a replacement for LGE and may only have utility in a very limited subset of DMD patients.

Myocardial Fibrosis in Pediatric Patients With Ebstein's Anomaly

2021 ◽  
Author(s):  
Safwat Aly ◽  
Mike Seed ◽  
Shi-Joon Yoo ◽  
Christopher Lam ◽  
Lars Grosse-Wortmann
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Right Ventricular ◽  
Children And Adolescents ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Severity Index ◽  
Left Ventricular ◽  
Ventricular Volumes ◽  
Native T1

Background: Left ventricular dysfunction in Ebstein's anomaly (EA) is associated with higher mortality. The health of the left ventricular myocardium in children and adolescents with EA has not been investigated in detail. Methods: Patients with unrepaired EA who had undergone cardiac magnetic resonance imaging including T1 mapping were retrospectively reviewed. Patients were compared with age- and sex-matched controls. EA severity index was calculated using volumetric measurements at end diastole ([right atrial+atrialized right ventricular volumes]/[functional right ventricular+left atrial+left ventricular volumes]). Global circumferential and radial strain and as well as strain rate were examined using cardiac magnetic resonance feature tracking. Results: Twelve EA patients and an equal number of controls were included. Functional and atrialized right ventricular end-diastolic volumes were 84±15 and 21±13 mL/m 2 , respectively. Late gadolinium enhancement, confined to the right ventricle, was found in 2 patients (16%). Left ventricular native T1 values and extracellular volume fractions were higher in patients compared with controls (1026±47 versus 956±40 ms, P =0.0004 and 28.5±3.4% versus 22.5±2.6%, P <0.001, respectively). Native T1 times correlated inversely with patients’ age, body surface area, and O 2 saturations (r=−0.63, −0.62, and −0.91, respectively; P =0.02, P =0.02, and P <0.0001, respectively). EA severity index ranged between 0.15 and 0.94 and correlated with T1 values (r=0.76, P =0.003). Native T1 correlated with global circumferential strain (r=0.58, P =0.04) but not ejection fraction (EF). EA patients had reduced maximum oxygen uptake (V o 2 max). V o 2 max correlated inversely with T1 values (r=−0.79, P =0.01). Conclusions: Children and adolescents with EA experience an abnormal degree of diffuse myocardial fibrosis. Its association with O 2 saturation points toward a role of hypoxemia in the pathogenesis of fibrosis. Larger and prospective studies are needed to evaluate the value of T1 mapping for risk stratification and monitoring in EA.

Abstract 13596: Magnetic Resonance - Derived Pre-contrast T1 Relaxation Time is the Accurate Marker of Diffuse Myocardial Fibrosis in Severe Aortic Valve Disease: A Comparison With Left Ventricular Myocardial Biopsy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Radka Kockova ◽  
Petr Kacer ◽  
Jan Pirk ◽  
Jiri Maly ◽  
Martina Vsianska ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
T1 Relaxation Time ◽  
Native T1 ◽  
T1 Relaxation ◽  
Myocardial Collagen

Introduction: Diffuse myocardial fibrosis (DFM) is the major mechanism in the pathophysiology of the aortic stenosis and its complications. DMF is detectable by magnetic resonance imaging (MRI) using the T1 mapping technique. Hypothesis: The MRI derived native T1 relaxation time and myocardial extracellular volume fraction (ECV) will be significantly related to the extent of DMF et targeted myocardial left ventricular (LV) biopsy. Methods: The study population consisted of 40 consecutive patients (age 63±8y, 65% males) undergoing surgery for severe aortic stenosis (77.5%), aortic root dilatation (7.5%) or valve regurgitation (15%). All patients underwent MRI-derived T1 mapping and 2D-, 3D speckle tracking-derived strain analysis prior to surgery. The T1 relaxation time was assessed in basal interventricular septum pre and 10 min post contrast administration using the modified Look-Locker Inversion recovery sequence. A LV myocardial biopsy specimen was obtained during surgery from basal interventricular septum under the guidance of the MRI operator to assure spatial concordance with the MRI assessment. The percentage of myocardial collagen was quantified as a ratio of Picrosirius Red-positive area over total sample area using the Image J. Results: The average percentage of myocardial collagen was 22 ± 14.8 %. The average native T1 relaxation time and ECV was 1010 ± 48 ms and 0.288 ± 0.055, respectively. Both native T1 relaxation time with cutoff value of ≥ 1010 ms (Ss=90%, Sp=73%, AUC =0.82) and ECV with cutoff value of ≥ 0.315 (Ss=80%, Sp=90%, AUC =0.85) showed high accuracy to identify extensive (> 30%) myocardial collagen content (Figure 1A, 1B). The native T1 mapping showed significant correlation with LV mass, 2D and 3D global longitudinal strain (all p<0.05) while the ECV did not (p=NS). Conclusions: Native T1 relaxation time is the accurate marker of diffuse myocardial fibrosis with the significant relationship with LV morphology and myocardial function.

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