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

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.

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Abstract 17448: A Novel Technique for Respiratory Motion Correction in Rapid Left Ventricular Myocardial T1 Mapping and Quantitative Analysis of Myocardial Fibrosis

Circulation ◽

10.1161/circ.130.suppl_2.17448 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Keigo Kawaji ◽

Marco Marino ◽

Akiko Tanaka ◽

Giacomo Tarroni ◽

Takeyoshi Ota ◽

...

Keyword(s):

Myocardial Fibrosis ◽

Motion Correction ◽

T1 Mapping ◽

Objective Evaluation ◽

Left Ventricular ◽

Myocardial Tissue ◽

Affine Motion ◽

Noise Characteristics ◽

T1 Map ◽

Myocardial T1

Introduction: Quantitative myocardial T1 mapping is increasingly being used to measure myocardial fibrosis, but this approach requires effective breath-holds during MRI. Respiratory artifacts from poor breath-holds result in motion-corrupted pixels and measurement error. We developed and tested the feasibility of an approach that applies motion correction (MC) followed by semi-automated segmentation to obtain motion-free T1 maps of the LV. Methods: Modified Look-Locker Inversion Recovery (MOLLI) data was acquired on 1.5T MRI scanner, where the endo- and epicardial borders were semi-automatically detected using noise characteristics of myocardial tissue [1,2] and followed by fully automated partitioning into AHA-defined segments [1]. Affine motion correction was then applied to each segment to generate MC-T1 maps of the heart. This approach was tested on 24 slices (12 before contrast injection [PRE]; 12 post [POST], 96x2 ROI segments) from 4 swine with no LV abnormality. The same segmented ROIs on T1 maps without MC were also assessed for comparison. Results: The standard deviation of T1 within each ROI became significantly lower after MC: [MC vs non-MC: 94 ± 37 vs 114 ± 51 ms (PRE, p<0.00005); 66 ± 51 vs 89 ± 67 ms (POST, p<0.0005)], suggesting less motion blurring and possibly less error in T1 measurements within each generated ROI (fig). Significant changes were observed in POST T1 values (446 ± 66 vs 435 ± 89ms; p < 0.0005), yielding an average increase of 2.6 ± 1.6% per segment. The inferior (+3.9%) and inferiolateral segments (+4.5%) yielded the most change, corresponding to regions with most motion across MOLLI images as assessed visually. PRE T1 changes were also significant (998 ± 94 vs 1008 ± 114 ms; p < 0.05). Conclusions: Our new semi-automated and motion-corrected T1 map assessment shows promise to improve the accuracy of T1 measurements but needs further validation in a larger dataset. This technique may become useful for objective evaluation of myocardial fibrosis.

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Relation of intestinal microbiota composition to extracellular matrix volume assessed by myocardial T1 mapping in patients with chronic heart failure and preserved left ventricular ejection fraction

Profilakticheskaya meditsina ◽

10.17116/profmed20212411128 ◽

2021 ◽

Vol 24 (11) ◽

pp. 28

Author(s):

A.N. Kaburova ◽

O.M. Drapkina ◽

S.M. Yudin ◽

S.N. Koretsky ◽

V.V. Makarov ◽

...

Keyword(s):

Heart Failure ◽

Extracellular Matrix ◽

Chronic Heart Failure ◽

T1 Mapping ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Microbiota Composition ◽

Ventricular Ejection Fraction ◽

Matrix Volume ◽

Myocardial T1

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Abstract 18922: Radiofrequency Catheter Ablation Reduces Diffuse Myocardial Fibrosis in Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.18922 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Promporn Suksaranjit ◽

Brent D Wilson ◽

Christopher J McGann ◽

Eugene G Kholmovski ◽

Imran Haider ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Myocardial Fibrosis ◽

Radiofrequency Catheter Ablation ◽

T1 Mapping ◽

Left Ventricular ◽

Diffuse Myocardial Fibrosis ◽

T1 Relaxation ◽

Lv Remodeling ◽

The Impact

Introduction: Atrial fibrillation (AF) is associated with diffuse myocardial fibrosis as quantified by cardiac magnetic resonance (CMR) using T1 mapping methods. Radiofrequency catheter ablation (RFCA) is evolving, and the role in rhythm control may be ideal for reversing left ventricular (LV) remodeling. Hypothesis: We aimed to study the impact of RFCA on diffuse myocardial fibrosis in AF patients. Methods: We retrospectively collected data from consecutive AF patients who underwent RFCA with modified Look-Locker Inversion recovery T1 mapping sequences on pre/post procedural CMR at 3.0-Tesla. Precontrast T1 relaxation time of the mid-LV short-axis view was used as an index of diffuse LV fibrosis. Primary outcome was the change in diffuse LV fibrosis after RFCA. Results: A total of 11 patients (mean age 67 years, 72% male, 67% paroxysmal AF) were enrolled. Median AF duration was 24.6 months [Interquartile range (IQR): 13.3-45.3)] and median CHA2DS2-VASc was 2 [IQR: 1-3]. Post RFCA CMR was obtained 99.5±18.1 days after the RFCA procedure. Mean precontrast T1 time was significantly lower after RFCA (1182ms vs 1158ms; p=0.0157). Conclusions: Based on our preliminary results, RFCA in AF reduces diffuse myocardial fibrosis and may play a role in reverse LV remodeling.

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

Blood ◽

10.1182/blood-2020-134585 ◽

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<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.

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O038 Diffuse myocardial fibrosis evaluated by post-contrast T1 mapping correlates with left ventricular stiffness

Global Heart ◽

10.1016/j.gheart.2014.03.1254 ◽

2014 ◽

Vol 9 (1) ◽

pp. e10

Author(s):

Andris H. Ellims ◽

James A. Shaw ◽

Dion Stub ◽

Leah M. Iles ◽

James L. Hare ◽

...

Keyword(s):

Myocardial Fibrosis ◽

T1 Mapping ◽

Left Ventricular ◽

Diffuse Myocardial Fibrosis ◽

Post Contrast ◽

Left Ventricular Stiffness

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ID: 6: HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY IN THE SETTING OF SYSTEMIC SCLERODERMA

Journal of Investigative Medicine ◽

10.1136/jim-2016-000120.17 ◽

2016 ◽

Vol 64 (4) ◽

pp. 919.1-919

Author(s):

R Sogomonian ◽

H Alkhawam ◽

S Lee ◽

D Chang ◽

EA Moradoghli Haftevani

Keyword(s):

Systemic Sclerosis ◽

Myocardial Fibrosis ◽

Hospice Care ◽

Vital Signs ◽

Restrictive Cardiomyopathy ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Left Ventricular ◽

Diffuse Fibrosis ◽

Septal Hypertrophy ◽

Hypertrophied Ventricle

Restrictive cardiomyopathy has been a common variant seen in systemic sclerosis (SS) with myocardial fibrosis. The association of SS with restrictive cardiomyopathy has well been established, but that with HOCM is not clearly understood. Herein, we report a case of a patient with SS, identified to have both HOCM and myocardial fibrosis.A 54-year-old woman with systemic sclerosis, idiopathic lung disease with moderate pulmonary hypertension, presented with fatigue, decreased appetite and shortness of breath. Vital signs were significant for oxygen saturation of 86% on room air, tachycardia of 117 bpm, and blood pressure of 110/53 mm Hg. Physical examination revealed diffuse rhonchi in all lung fields, malar rash and skin excoriation in bilateral lower extremities without edema. Laboratory studies were significant for elevated brain natriuretic peptide (BNP) of 858 pg/mL. Transthoracic echocardiography revealed left ventricular hypertrophy (LVH) with ejection fraction of 78%. Electrocardiography illustrated LVH. Cardiac magnetic resonance imaging (cMRI) was significant for severe left ventricular cardiac asymmetric septal hypertrophy with outflow obstruction caused by anterior motion of the mitral valve. Cardiac biopsy revealed evidence of diffuse fibrosis, but did not show iron, glycogen, or amyloid depositions.Patient was maintained on mycophenolate mofetil, low dose of methylprednisolone, morphine, clonazepam and transferred to hospice care.Hypertrophic obstructive cardiomyopathy (HOCM) is the most common genetic cardiac disorder with an autosomal dominant transmission. It is characterized by asymmetric LVH out of proportion of systemic after load. The most common cardiac involvement in SS is myocardial fibrosis in a restrictive pattern, while HOCM is rarely seen in SS.Abstract ID: 6 Figure 1Cardiac MRI demonstrating hypertrophied ventricle with fibrosis. This image demonstrates the features of both hypertrophic and restrictive cardiomyopathy.

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