scholarly journals Native T1 mapping for differential diagnosis of left ventricular hypertrophy

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
D Lavall ◽  
NH Vosshage ◽  
S Stoebe ◽  
T Denecke ◽  
A Hagendorff ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Cardiac Amyloidosis ◽  
T1 Mapping ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Characteristic Analysis ◽  
Native T1 ◽  
Healthy Control

Abstract Funding Acknowledgements Type of funding sources: None. Purpose The aim of this study was to investigate native T1 mapping cardiac magnetic resonance (CMR) tomography for the differential diagnosis of left ventricular (LV) hypertrophy. Background Mapping techniques are useful to characterize myocardial tissue abnormalities, particularly cardiac amyloidosis. However, specific cut-off values to differentiate LV hypertrophic phenotypes on 3.0 tesla CMR scanners have not been established, yet. Methods We retrospectively identified patients in the CMR database of Leipzig university hospital with increased LV wall thickness (≥12mm diameter at end-diastole) who were referred for the evaluation of LV hypertrophy or ischemia between 2017 and 2020 on a 3T scanner (Philips Achieva). Patients with suspected or confirmed myocarditis were excluded. Diagnosis of cardiac amyloidosis was made by either biopsy or non-invasively by bone scintigraphy and screening for monoclonal gammopathy. T1 mapping was measured as global mean value from 3 short axis slices of the LV. Results 128 consecutive patients were included in the study. 31 subjects without evidence of structural heart disease served as healthy control. The final diagnosis was cardiac amyloidosis in 24 patients (5 patients with light-chain, 18 with transthyretin amyloidosis, 1 undetermined), hypertrophic cardiomyopathy in 24, and hypertensive heart disease in 80 patients. Mean age of patients was 65 ± 13years, 84% were male. LV mass was increased in patients with LV hypertrophy compared to healthy control (p < 0.001). Native T1 values of the LV myocardium were higher in patients with cardiac amyloidosis (1409 ± 59ms, p < 0.0001 vs. all other groups) compared to healthy control (1225 ± 21ms), patients with hypertrophic cardiomyopathy (HCM; 1263 ± 43ms) and hypertensive heart disease (HHD; 1257 ± 41ms) (Figure). Patients with hypertrophic cardiomyopathy and hypertensive heart disease did not differ in their native T1 values, but both groups were increased compared to healthy control (p < 0.01). Receiver operating characteristic analysis of native T1 values demonstrated an area under the curve for the detection of cardiac amyloidosis of 0.9954 (p < 0.0001) vs. hypertrophic cardiomyopathy, hypertensive heart disease and healthy control. The optimal cut-off value was 1341ms, with a sensitivity of 100% and a specificity of 97%. Conclusion Native T1 mapping has high diagnostic accuracy for the diagnosis of cardiac amyloidosis among patients with LV hypertrophy. These data need confirmation in a prospective clinical trial. Study ID DRKS00022048

scholarly journals CMR-based T1-mapping offers superior diagnostic value compared to longitudinal strain-based assessment of relative apical sparing in cardiac amyloidosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dennis Korthals ◽  
Grigorios Chatzantonis ◽  
Michael Bietenbeck ◽  
Claudia Meier ◽  
Philipp Stalling ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
T1 Mapping ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Cine Imaging ◽  
Characteristic Analysis ◽  
Post Contrast ◽  
Native T1

AbstractCardiac amyloidosis (CA) is an infiltrative disease. In the present study, we compared the diagnostic accuracy of cardiovascular magnetic resonance (CMR)-based T1-mapping and subsequent extracellular volume fraction (ECV) measurement and longitudinal strain analysis in the same patients with (a) biopsy-proven cardiac amyloidosis (CA) and (b) hypertrophic cardiomyopathy (HCM). N = 30 patients with CA, N = 20 patients with HCM and N = 15 healthy control patients without relevant cardiac disease underwent dedicated CMR studies. The CMR protocol included standard sequences for cine-imaging, native and post-contrast T1-mapping and late-gadolinium-enhancement. ECV measurements were based on pre- and post-contrast T1-mapping images. Feature-tracking analysis was used to calculate 3D left ventricular longitudinal strain (LV-LS) in basal, mid and apical short-axis cine-images and to assess the presence of relative apical sparing. Receiver-operating-characteristic analysis revealed an area-under-the-curve regarding the differentiation of CA from HCM of 0.984 for native T1-mapping (p < 0.001), of 0.985 for ECV (p < 0.001) and only 0.740 for the “apical-to-(basal + midventricular)”-ratio of LV-LS (p = 0.012). A multivariable logistical regression analysis showed that ECV was the only statistically significant predictor of CA when compared to the parameter LV-LS or to the parameter “apical-to-(basal + midventricular)” LV-RLS-ratio. Native T1-mapping and ECV measurement are both superior to longitudinal strain measurement (with assessment of relative apical sparing) regarding the appropriate diagnosis of CA.

scholarly journals Radiomic Analysis of Myocardial Native T1 Imaging Discriminates Between Hypertensive Heart Disease and Hypertrophic Cardiomyopathy

2019 ◽  
Vol 12 (10) ◽  
pp. 1946-1954 ◽  
Author(s):  
Ulf Neisius ◽  
Hossam El-Rewaidy ◽  
Shiro Nakamori ◽  
Jennifer Rodriguez ◽  
Warren J. Manning ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Hypertensive Heart Disease ◽  
Native T1

scholarly journals Cardiovascular magnetic resonance in hypertrophic cardiomyopathy and infiltrative cardiomyopathy

2016 ◽  
Vol 20 (2) ◽  
Author(s):  
Rebecca Schofield ◽  
Katia Manacho ◽  
Silvia Castelletti ◽  
James C. Moon
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
T1 Mapping ◽  
Strong Predictor ◽  
Extracellular Volume ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Tissue Characterisation ◽  
Alcohol Ablation

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. Cardiac imaging plays a key role in the diagnosis and management, with cardiovascular magnetic resonance (CMR) an important modality. CMR provides a number of different techniques in one examination: structure and function, flow imaging and tissue characterisation particularly with the late gadolinium enhancement (LGE) technique. Other techniques include vasodilator perfusion, mapping (especially T1 mapping and extracellular volume quantification [ECV]) and diffusion-weighted imaging with its potential to detect disarray. Clinically, the uses of CMR are diverse. The imaging must be considered within the context of work-up, particularly the personal and family history, Electrocardiogram (ECG) and echocardiogram findings. Subtle markers of possible HCM can be identified in genotype positive left ventricular hypertrophy (LVH)-negative subjects. CMR has particular advantages for assessment of the left ventricle (LV) apex and is able to detect both missed LVH (apical and basal antero-septum), when the echocardiography is normal but the ECG abnormal. CMR is important in distinguishing HCM from both common phenocopies (hypertensive heart disease, athletic adaptation, ageing related changes) and rarer pheno and/or genocopies such as Fabry disease and amyloidosis. For these, in particular the LGE technique and T1 mapping are very useful with a low T1 in Fabry’s, and high T1 and very high ECV in amyloidosis. Moreover, the tissue characterisation that is possible using CMR offers a potential role in patient risk stratification, as scar is a very strong predictor of future heart failure. Scar may also play a role in the prediction of sudden death. CMR is helpful in follow-up assessment, especially after septal alcohol ablation and myomectomy.

Clinical impact of native T1 mapping for detecting myocardial impairment in takotsubo cardiomyopathy

2019 ◽  
Vol 20 (10) ◽  
pp. 1147-1155 ◽  
Author(s):  
Yukio Aikawa ◽  
Teruo Noguchi ◽  
Yoshiaki Morita ◽  
Emi Tateishi ◽  
Atsushi Kono ◽  
...  
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Wall Motion ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Clinical Impact ◽  
Left Ventricular Ejection ◽  
Basal Region ◽  
Characteristic Analysis ◽  
Ventricular Ejection Fraction ◽  
Native T1

Abstract Aims To investigate the clinical impact of T1 mapping for detecting myocardial impairment in takotsubo cardiomyopathy (TTC) over time. Methods and results In 23 patients with the apical ballooning type of TTC, the following 3T magnetic resonance (MR) examinations were performed at baseline and 3 months after TTC onset: T2-weighted imaging, T2 mapping, native T1 mapping, extracellular volume fraction (ECV), and late gadolinium enhancement. Eight healthy controls underwent the same MR examinations. Serial echocardiography was performed daily for ≥7 days and monthly until 3 months after onset. The median time from onset to MR examination was 7 days. During the acute phase, patients had, relative to controls, higher native T1 (1438 ± 162 vs. 1251 ± 90 ms, P < 0.001), ECV (35 ± 5% vs. 29 ± 4%, P < 0.001), and T2 (90 ± 34 vs. 68 ± 12 ms, P < 0.001) for the entire heart. Per-region analysis showed that higher native T1 and T2 in the basal region were correlated with lower left ventricular ejection fraction (r = −0.599, P = 0.004 and r = −0.598, P = 0.003, respectively). Receiver operator characteristic analysis showed that the area under the curve for native T1 (0.96) was significantly larger than that for T2 (0.86; P = 0.005) but similar to that for ECV (0.92; P = 0.104). At 3-month follow-up, native T1, ECV, and T2 in the apical region remained significantly elevated in all patients with TTC. The number of left ventricular (LV) segments with elevated native T1 (cut-off value 1339 ms) was significantly correlated with prolonged LV wall motion recovery time (r = 0.494, P = 0.027). Conclusion Characterization of myocardium with native T1 mapping is a promising method for predicting LV wall motion restoration in TTC.

Abstract 705: The Difference in Left Ventricular Twisting Behavior Between Patients With Hypertensive Heart Disease and Hypertrophic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kazuhisa Nishimura ◽  
Hideki Okayama ◽  
Makoto Saito ◽  
Katsuji Inoue ◽  
Toyofumi Yoshii ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Control Group ◽  
Control Groups ◽  
The Difference ◽  
And Control

(Background) Left ventricular (LV) untwisting behavior is a novel index of LV diastolic function since it is a powerful determinant of LV diastolic suction. The LV of patients with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) has diastolic dysfunction despite normal systolic function. However, the role of untwisting behavior in HCM and HHD in the pathophysiology of diastolic dysfunction is unknown. The aim of this study was to investigate the difference of LV twisting behavior between patients with HCM and HHD. (Methods) Forty-four patients with HCM (mean age, 63+/−15 y, 34 males), 30 patients with HHD (mean age, 62+/−12 y, 20 males), and 20 age and sex-matched control subjects were evaluated. After a standard echocardiographic examination, LV twist and twisting velocity profiles from apical and basal short-axis images were analyzed using two-dimensional speckle tracking imaging. All temporal parameters were normalized by R-R intervals. (Results) LV diastolic and systolic dimensions, and ejection fraction were not significantly different among the groups. LV mass index and early diastolic mitral annular velocity were not significantly different between the HCM and HHD groups. The peak torsion in the HCM and HHD groups was significantly greater than that in the control group (Table ). The peak untwisting velocity in the HCM group was comparable to that in the control group. However, when the peak untwisting velocity was corrected by peak torsion, the value in the HCM group was significantly decreased compared with that in the HHD and control groups. The time to peak untwisting velocity from aortic valve closure in the HCM group was significantly longer than that in the HHD and control groups. (Conclusion) These results suggest that enhanced peak torsion in HCM might compensate for untwisting behavior, but this mechanism fails to fully compensate for untwisting behavior compared with HHD. Left ventricular twisting behavior

Left ventricular septal convexity in differentiating hypertrophic cardiomyopathy from hypertensive heart disease – cardiac MRI study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Tarkiainen ◽  
P Sipola ◽  
M Jalanko ◽  
T Helio ◽  
P Jaaskelainen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Hypertensive Heart Disease ◽  
Clinical Problem ◽  
Left Ventricular ◽  
University Hospital ◽  
Funding Source ◽  
Cardiovascular Research ◽  
Endocardial Border ◽  
Cutoff Value

Abstract Background Subjects with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) have left ventricular hypertrophy (LVH). It is a common clinical problem to distinguish HCM from HHD. Septal convexity (SC) into the left ventricle is increased in subjects with hypertrophic cardiomyopathy (HCM)-causing mutations with and without LVH. Purpose Our objective was to study if SC by cardiac magnetic resonance (CMR) differentiates between HCM and HHD. Methods We measured SC in 29 subjects with hypertension and LVH (left ventricular maximal wall thickness (LVMWT) ≥13 mm), in 49 subjects with HCM (LVMWT ≥13 mm) caused by the D175N mutation in the alpha-tropomyosin (TPM1) or the Q1061X mutation in the myosin binding protein C (MYBPC3) genes, and in 20 healthy controls with no LVH. SC into the LV was measured in end-diastolic 4-chamber images as the maximal distance between LV septal endocardial border and a line connecting septal mid-wall points at the level of tricuspid valve insertion and at the level of apical right ventricular insertion on the LV. Results Subjects with HCM had significantly increased septal convexity compared to subjects with HHD both in non-indexed and in BSA-indexed measurements (10.7±4.0 mm vs 4.9±2.7 mm, P&lt;0.001 and 5.5±2.1 mm/m2 vs 2.4±1.3 mm/m2, P&lt;0.001). To differentiate between HCM and HHD, septal convexity cutoff value of 7.85 mm performed best with sensitivity of 77% and specificity of 90%. BSA-indexed SC cutoff value of 3.68 mm differentiated between HCM and HHD with sensitivity of 81% and specificity of 86%. Conclusions CMR derived septal convexity is easily measured and is useful in discriminating between HCM caused by sarcomere mutations versus HHD. Measurement of septal convexity Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Foundation of Cardiovascular Research, the special governmental subsidy for health sciences research of the University Hospital of Kuopio

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