scholarly journals Cardiac MRI T1 mapping and extracellular volume application in hypertrophic cardiomyopathy

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Nahla D. Ali ◽  
Noha Behairy ◽  
Ahmed Kharabish ◽  
Wesam Elmozy ◽  
Ahmed Yahya Hegab ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Diffuse Fibrosis ◽  
Proton Relaxation ◽  
Wide Range ◽  
Significant Difference

Abstract Background Hypertrophic cardiomyopathy (HCM) is one of the commonest inheritable cardiac disorders. Being a global disease with diffuse myocardial fibrosis, it has a wide range of adverse outcomes ending with sudden cardiac death. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) has become a reference standard for visualization of focal myocardial fibrosis. In the setting of less severe or more diffuse fibrosis, LGE is unlikely to reveal the presence of abnormal tissue given the lack of normal myocardium as a reference. Direct measurement of myocardial T1 time (T1 mapping) may improve these methodologic problems of LGE CMR in the setting of diffuse retention of gadolinium-based contrast material. So, we aim at this study to evaluate the clinical application of CMRI native and post-contrast T1 relaxation in assessing diffuse myocardial fibrosis non-invasively in hypertrophic cardiomyopathy. Results There was a significant difference between the percent of fibrosis detected by measuring the extracellular volume percent compared to that detected by LGE, with the former detecting fibrosis in 45.1% of the examined cardiac segments while the latter showed fibrosis in 20.9% of the cardiac segments. Also, measuring the native T1 values showed evidence of fibrosis in about 32.2% of the cardiac segments superseding the percent of fibrosis detected using the LGE alone. The ejection fraction percent showed a negative correlation with the left ventricular mass with a correlation coefficient value of − 0.139 where both interstitial and replacement fibrosis play an important role in the pathophysiology of diastolic dysfunction as well as impairing the myocardial contractility. Also, in cases of obstruction, the extracellular volume (ECV) is more likely to increase in the basal anterior and antero-septal segments as well as the basal inferior segment with P values 0.015, 0.013, and 0.045, respectively. Conclusion Diffuse fibrosis was found to be difficult to be distinguished using LGE. The unique ability of CMR to use proton relaxation times provides a quantitative measurement to detect increased interstitial volume in diffuse myocardial fibrosis. Moreover, it showed that in cases of obstruction, the segments exposed to the highest pressure are more vulnerable to the fibrotic process denoting a relationship between the pressure gradient and the adverse myocardial remodeling.

Abstract 18283: Left Ventricular STIFFness vs. Fibrosis Quantification by T1 MAPping in Heart Failure With Preserved Ejection Fraction - STIFFMAP-HFpEF

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Karl-Philipp Rommel ◽  
Max von Roeder ◽  
Thomas Stiermaier ◽  
Konrad Latuscynski ◽  
Christian Oberueck ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Preserved Ejection Fraction ◽  
Stiffness Constant

Introduction: Heart Failure with Preserved Ejection Fraction (HFpEF) is an increasing public health problem. To tailor successful treatment strategies it is essential to identify patients’ individual pathologies contributing to HFpEF. Cardiac magnetic resonance (CMR) derived T1-Mapping has been suggested as non-invasive tool to quantify diffuse myocardial fibrosis. Invasive tracings of pressure-volume relations represent the gold-standard for assessing load-independent mechanical diastolic properties of the left ventricle. Hypothesis: Aim of this study was therefore to elucidate the diagnostic performance of T1-Mapping in HFpEF patients by examining the relationship between the extracellular volume fraction (ECV) and invasively measured parameters of diastolic function and to study the potential of ECV to differentiate between different pathomechanisms in HFPEF. Methods: We performed CMR T1-Mapping in 21 patients with HFpEF and 11 patients without heart failure symptoms (further referred to as controls). Pressure volume loops were obtained with a conductance catheter during basal conditions and handgrip exercise. Transient preload reduction was used to extrapolate the diastolic stiffness constant. Results: Patients with HFpEF showed a higher extra cellular volume fraction (p=0.001), an elevated load-independent passive LV stiffness constant - ß (p<0.001) and a longer time constant of active LV-relaxation Tau (p=0.04). ECV correlated well with ß (r =0.75, p <0.001). After multivariate analysis, ECV remained the only independent predictor of ß. Within the HFpEF cohort, patients with ECV over median showed higher left ventricular masses (p=0.04) and a higher LV stiffness (p=0.05). ECV < median identified patients with a prolonged active LV relaxation (p=0.008) and a marked hypertensive reaction to exercise due to a pathologic arterial elastance (p=0.05). Conclusions: Diffuse myocardial fibrosis, assessed by CMR derived T1-Mapping independently predicts invasively measured LV stiffness in HFpEF. In addition, ECV helps to non-invasively distinguish the role of impaired active relaxation and passive stiffness and refines characterization of patients, which represents a prerequisite for any successful therapy in the future.

Abstract 15137: Detection of Diffuse Myocardial Fibrosis using Multi-slice T1 Mapping by Slice Interleaved T1 (STONE) Sequence in Patients With Hypertrophic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shingo Kato ◽  
Sébastien Roujol ◽  
Jihye Jang ◽  
Tamer Basha ◽  
Sophie Berg ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
Wall Thickness ◽  
T1 Mapping ◽  
Free Breathing ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Mapping Technique ◽  
Native T1 ◽  
Native T1 Time

Introduction: In hypertrophic cardiomyopathy (HCM), there are significant variations in left ventricular (LV) wall thickness and fibrosis, which necessitates a volumetric coverage. Slice-interleaved T1 (STONE) mapping sequence allows for the assessment of native T1 time with complete coverage of LV myocardium. Hypothesis: We hypothesized that STONE sequence is useful for the assessment of regional native T1 time abnormality in HCM patients. Methods: Twenty-four septal HCM patients (56±16 years) and 10 healthy adult control subjects (57±15 years) were studied. Native T1 mapping was performed using STONE sequence which enables acquisition of 5 slices in the short-axis plane within a 90 sec free-breathing scan. We measured LV native T1 time and maximum LV wall thickness in each 16 segments from 3 slices (basal-, mid- and apical-slice) and evaluated the relationship between LV native T1 time and wall thickness. Late gadolinium enhanced (LGE) MRI was acquired to assess presence of myocardial enhancement. Results: In HCM patients, LV native T1 time was significantly elevated compared to healthy controls, regardless of presence or absence of LGE (mean native T1 time; LGE (+) segments (n=27), 1139±55 msec; LGE (-) segments (n=351), 1118±55 msec; healthy control (n=160),1065±35 msec; p<0.001 by one-way ANOVA, 6 segments were excluded from analysis due to artifacts). Among 351 segments without LGE, native LV T1 time was diffusely elevated over the 16 segments (Figure). Significant positive correlation was found between LV wall thickness and native LV T1 time (y=1013+8.7x, p<0.001). Conclusions: In HCM, substantial number of segments without LGE showed elevated native T1 time, and native T1 time was correlated with LV wall thickness. Multi-slice T1 mapping by using STONE sequence could be advantageous to overcome limited cardiac coverage of conventional single-slice T1 mapping technique and to accurately detect the diffuse myocardial fibrosis in HCM patients.

scholarly journals The link between left ventricular extracellular volume determined by T1 myocardial mapping and gut microbiota composition in individuals with heart failure and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N Kaburova ◽  
O.M Drapkina ◽  
S.M Uydin ◽  
M.V Vishnyakova ◽  
M.S Pokrovskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gut Microbiota ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Rrna Gene ◽  
Preserved Ejection Fraction

Abstract Introduction Heart failure with preserved ejection fraction (HFpEF) represents a major challenge in modern cardiology. As described previously, in HFpEF comorbidities promote a systemic inflammatory state, leading to diffuse myocardial fibrosis resulting in myocardial stiffening. Gut dysbiosis which is considered as the novel source of chronic systemic inflammation has been actively investigated as the risk factor for the development and aggravation of cardiovascular diseases including heart failure. Cardiac magnetic resonance T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. Moreover, the extracellular volume (ECV) fraction can be calculated, providing information on the relative expansion of the extracellular matrix, thus being a noninvasive alternative to myocardial biopsy studies. Purpose The research was aimed at investigating the correlation between the left ventricular ECV and gut microbial genera in patients with HFpEF. Methods 42 patients with confirmed HF-pEF (mediana and interquartile range of age 67 [64; 72] years, 47% men, body mass index &lt;35 kg/m2 with no history of myocardial infarction or diabetes mellitus) were enrolled in the study. The patients underwent transthoracic echocardiography with Doppler study, HF-pEF was confirmed according to the recent ESC guidelines (based on E/e' ratio, N-terminal pro-B type natriuretic peptide &gt;125 pg/ml and symptoms of heart failure). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. As the last step of research T1-myocardial mapping with the modified look-locker inversion-recovery protocol (MOLLI) sequence at 1.5 Tesla was performed to assess left ventricular extracellular volume fraction. Results The mean±std in ECV was 31.02±4.4%. The relative abundance (%) of the most prevalent phyla in gut microbiota was 48±22.5 for Firmicutes, 47.4±22.8 for Bacteroidetes and 1.5 [1.5; 2.5] for Proteobacteria. The analysis showed significant negative correlations between ECV and the following bacterial genera: Faecalibacterium (r=−0.35), Blautia (r=−0.43), Lachnoclostridium (r=−0.32). Moreover ECV positively correlated with Holdemania (r=0.4), Victivallis (r=0.38), Dehalobacterium (r=0.38), Enterococcus (r=0.33) and Catabacter (r=0.32). All correlation values with p&lt;0.05. Conclusion We discovered both negative and positive significant correlations between ECV – the non-invasive marker of myocardial fibrosis and several bacterial genera, which may have negative impact on myocardial remodeling in HF-pEF. Funding Acknowledgement Type of funding source: None

scholarly journals Proteoglycan remodeling is accelerated in women with angina pectoris and diffuse myocardial fibrosis: the iPOWER Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.D Mygind ◽  
S Holm Nielsen ◽  
M Mide Michelsen ◽  
A Pena ◽  
D Bechsgaard Frestad ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Angina Pectoris ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Obstructive Coronary Artery Disease ◽  
Extracellular Volume ◽  
Diffuse Myocardial Fibrosis ◽  
Public Institution ◽  
Funding Source

Abstract Background Women with angina and no obstructive coronary artery disease (CAD) have an unfavourable prognosis, possibly due to coronary microvascular disease and diffuse myocardial fibrosis (DMF). In DMF myocardial extracellular matrix (ECM) proteins are actively remodeled by matrix metalloproteinase (MMP). Purpose We investigated MMP-mediated degradation of the protegoglycans biglycan and versican in women with angina pectoris and possible DMF assessed by cardiac magnetic resonance T1 mapping. Methods Seventy-one women with angina pectoris and no obstructive CAD were included. Asymptomatic age-matched women served as controls (n=32). Versican and biglycan were measured in serum by specific competitive enzyme-linked immunosorbent assays. T1 mapping was performed by cardiac magnetic resonance with gadolinium measuring T1 and extracellular volume (ECV). Results Both biglycan and versican levels were higher in symptomatic women compared with controls; 31.4 ng/mL vs. 16.4 ng/mL (p&lt;0.001) and 2.1 ng/mL vs. 1.8 ng/mL (p&lt;0.001), respectively (Figure 1) and were moderately correlated to global ECV (r2=0.38, p&lt;0.001 and r2=0.26, p=0.015 respectively). Conclusion Turnover of biglycan and versican was increased in symptomatic compared to asymptomatic women and associated to ECV, supporting a link between angina with no obstructive CAD and fibrotic cardiac remodeling. The examined biomarkers may prove to be suitable for monitoring active ECM remodeling. Figure 1. Levels of BGM and VCANM Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): This work was supported by The Danish Heart Foundation, the Danish Research Fund (Den Danske Forskningsfond) and by University of Copenhagen.

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

Circulation ◽  
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.

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.

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

Global Heart ◽  
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

scholarly journals T1-mapping and extracellular volume in patients with hypertrophic cardiomyopathy without focal myocardial injury in late gadolinium enhancement sequence

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
P Gac ◽  
B Kedzierski ◽  
K Truszkiewicz ◽  
R Poreba
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Myocardial Injury ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Post Contrast ◽  
Mapping Sequence ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background The LGE (late gadolinium enhancement) sequence is a recognized classic tool for imaging focal myocardial injury. The T1-mapping sequence to assess native T1 myocardial time, post-contrast T1 time, and myocardial extracellular volume (ECV) is a widely studied tool for imaging focal and diffused myocardial injury. Purpose The aim of the study was to evaluate the native T1 time, the post-contrast T1 time and the myocardial extracellular volume in the T1-mapping sequence in patients with hypertrophic cardiomyopathy without focal LGE myocardial injury. Methods The study group consisted of 28 consecutive patients who met the criteria for diagnosis of hypertrophic cardiomyopathy without focal LGE myocardial injury (HCM group; mean age 52.17 ± 6.35 years). 28 patients without cardiomyopathy (CON group; mean age 51.76 ± 6.49 years) with similar anthropometric parameters were selected by the case-to-case method as a control group. All patients underwent 1.5 T cardiac magnetic resonance, including cinematographic sequences (CINE), LGE sequence and T1-mapping sequences before (native) and 20-minutes after intravenous administration of a paramagnetic agent (post-contrast). In the T1-mapping sequences, the mean T1 time of the whole myocardium (T1 whole myocardium) was assessed, as well as the T1 time in the basal layers (T1 basal), middle layers (T1 middle) and apical layers (T1 apical) of the myocardium. Moreover, the mean T1 time was assessed in the 16-segment myocardial AHA model (T1 segment 1-16). The extracellular volume of the myocardium was estimated in an analogous way. Results In CINE sequences, in the HCM group compared to the CON group, the end-diastolic thickness of the anterior part of interventricular septum, the end-diastolic thickness of the left ventricular posterior wall and the left ventricular mass index were significantly higher. The studied groups did not differ in left ventricular ejection fraction. In both groups, no foci of myocardial injury in the LGE sequence were found. There were no statistically significant differences in T1 times between the study groups. In the HCM group as compared to the CON group, the ECV whole myocardium, ECV basal, ECV apical and ECV segments 1-3, 8, 13-16 were statistically significantly higher. Conclusion Patients with hypertrophic cardiomyopathy without myocardium focal injury in the LGE sequence are characterized by higher myocardial ECV values, assessed in the T1-mapping sequence.

Abstract 16798: Evidence of Abnormal T1 Mapping in Arrhythmic Mitral Valve Prolapse Without Significant Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian B Agbor-Etang ◽  
Lisa J Lim ◽  
Karen G Ordovas ◽  
Francesca N Delling
Keyword(s):  
Late Gadolinium Enhancement ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Ventricular Arrhythmias ◽  
T1 Mapping ◽  
Diffuse Myocardial Fibrosis ◽  
Diffuse Fibrosis ◽  
Gadolinium Enhancement

Background: Prior cardiac magnetic resonance (CMR) studies have reported abnormal T1 mapping, reflective of diffuse myocardial fibrosis, in patients with mitral valve prolapse (MVP) and ventricular arrhythmias. However, T1 mapping was derived from conventional Look-Locker sequences and/or obtained in selected MVP patients with severe mitral regurgitation (MR) and a clinical indication for CMR. Hypothesis: We hypothesize that extracellular volume (ECV) fraction, a marker of diffuse fibrosis derived from research-based, MOLLI T1 mapping sequences, is increased in MVP subjects with ventricular arrhythmias, even in the absence of significant MR. Methods: We performed CMRs in 10 consecutive, randomly selected MVP patients identified through our echocardiographic database, age/gender matched to 10 controls free of significant cardiac disease. All 10 MVPs underwent ambulatory EKG monitoring. CMR images were acquired using a GE 3.0T Discovery MR750w scanner. Global ECV fraction was calculated using pre- and 10 minutes post-contrast T1 times after administration of 0.1 mmol/kg of gadobutrol (Gadavist). Late gadolinium enhancement (LGE) was also obtained. MR fraction was quantified by velocity encoded CMR. Mild MR was defined as MR fraction < 16%. Results: MVP patients had significantly higher ECV fraction compared to controls (mean ECV (%) 32 ± 4 vs 20 ± 6, p = 0.0002), with 5/10 demonstrating non-sustained VT on ambulatory EKG monitoring. The majority (9/10 or 90%) of MVPs had mild or no MR (MR fraction < 16%), and 1/10 or 10% had moderate MR (MR fraction 18%). Only one individual in the MVP group had late gadolinium enhancement (LGE) in the papillary muscles. Conclusion: MVP with ventricular arrhythmias is associated with increased global ECV reflective of diffuse myocardial fibrosis, even in the absence of significant MR or LGE. Our preliminary findings highlight for the first time a primary interstitial derangement in MVP. Larger studies are needed to understand the mechanisms and prognostic significance of primary diffuse fibrosis in MVP.

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