Faculty Opinions recommendation of Native T1 mapping and extracellular volume mapping for the assessment of diffuse myocardial fibrosis in dilated cardiomyopathy.

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<0.001) and 2.1 ng/mL vs. 1.8 ng/mL (p<0.001), respectively (Figure 1) and were moderately correlated to global ECV (r2=0.38, p<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.

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RETRACTED ARTICLE: Prognostic value of heart failure in hemodialysis-dependent end-stage renal disease patients with myocardial fibrosis quantification by extracellular volume on cardiac magnetic resonance imaging

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-01313-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Hua-yan Xu ◽

Zhi-gang Yang ◽

Yi Zhang ◽

Wan-lin Peng ◽

Chun-chao Xia ◽

...

Keyword(s):

Heart Failure ◽

Myocardial Fibrosis ◽

Prognostic Value ◽

T1 Mapping ◽

Extracellular Volume ◽

Cardiac Events ◽

Native T1 ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients are at high cardiovascular risk, and myocardial fibrosis (MF) accounts for most of their cardiac events. The purpose of this study is to investigate the prognostic value and risk stratification of MF as measured by extracellular volume (ECV) on cardiac magnetic resonance (CMR) for heart failure (HF) in patients with hemodialysis-dependent ESRD. Methods Sixty-six hemodialysis ESRD patients and 25 matched healthy volunteers were prospectively enrolled and underwent CMR to quantify multiple parameters of MF by T1 mapping and late gadolinium enhancement (LGE). All ESRD patients were followed up for 11–30 months, and the end-point met the 2016 ESC guidelines for the definition of HF. Results Over a median follow-up of 18 months (range 11–30 months), there were 26 (39.39%) guideline-diagnosed HF patients in the entire cohort of ESRD subjects. The native T1 value was elongated, and ECV was enlarged in the HF cohort relative to the non-HF cohort and normal controls (native T1, 1360.10 ± 50.14 ms, 1319.39 ± 55.44 ms and 1276.35 ± 56.56 ms; ECV, 35.42 ± 4.42%, 31.85 ± 3.01% and 26.97 ± 1.87%; all p<0.05). In the cardiac strain analysis, ECV was significantly correlated with global radial strain (GRS) (r = − 0.501, p = 0.009), global circumferential strain (GCS) (r = 0.553, p = 0.005) and global longitudinal strain (GLS) (r = 0.507, p = 0.008) in ESRD patients with HF. Cox proportional hazard regression models revealed that ECV (hazard ratio [HR] = 1.160, 95% confidence interval: 1.022 to 1.318, p = 0.022) was the only independent predictor of HF in ESRD patients. It also had a higher diagnostic accuracy for detecting MF (area under the curve [AUC] = 0.936; 95% confidence interval: 0.864 to 0.976) than native T1 and post T1 (all p ≤ 0.002). Kaplan-Meier analysis revealed that the high-ECV group had a shorter median overall survival time than the low-ECV group (18 months vs. 20 months, log-rank p = 0.046) and that ESRD patients with high ECV were more likely to have HF. Conclusions Myocardial fibrosis quantification by ECV on CMR T1 mapping was shown to be an independent risk factor of heart failure, providing incremental prognostic value and risk stratification for cardiac events in ESRD patients. Trial registration Chinese Clinical Trial Registry ChiCTR-DND-17012976, 13/12/2017, Retrospectively registered.

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Relationship between cardiac magnetic resonance derived extracellular volume fraction and myocardial strain in patients with non-ischemic dilated cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0239 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Azuma ◽

S Kato ◽

S Kodama ◽

K Hayakawa ◽

M Kagimoto ◽

...

Keyword(s):

Magnetic Resonance ◽

Dilated Cardiomyopathy ◽

Myocardial Fibrosis ◽

Negative Correlation ◽

T1 Mapping ◽

Myocardial Strain ◽

Extracellular Volume ◽

P Values ◽

Chamber View ◽

Non Ischemic Dilated Cardiomyopathy

Abstract Background The feature tracking (FT) technique has been proposed as a robust method to evaluate the myocardial strain using conventional cine magnetic resonance imaging (MRI) of the left ventricle. Data is limited regarding the relationship between FT-derived myocardial strain and diffuse myocardial fibrosis evaluated by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM). Purpose The aim of this study was to evaluate the correlation between extracellular volume (ECV) by T1 mapping and myocardial strain by FT in patients with NIDCM. Methods A total of sixty-four patients with NIDCM (62±12 years) and 15 controls (62±11 years) were studied. Using a 1.5T MR scanner, pre- and post- T1 mapping images of LV wall at mid-ventricular level was acquired to calculate ECV by modified Look-Locker inversion recovery (MOLLI) sequence. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was assessed by FT technique. ECV and myocardial strain were compared using a 6-segment model at mid-ventricular level. Results Compared to the controls, the NIDCM patients had a significantly higher ECV (0.30±0.02 vs. 0.24±0.01, p<0.001) and impaired myocardial strain (RS, 24.2±3.0 vs. 52.2±6.2, p<0.001; CS, −7.5±2.1 vs. −15.3±2.2, p<0.001; LS −10.4±3.5 vs. −20.2±4.7, p<0.001, respectively). Similar results were obtained when comparing all 6 myocardial segments (segment 7–12) (all p values <0.001). In a segment-based analysis, a significant positive correlation was found between the ECV and CS (r=0.26 to 0.41; all p values <0.05), a negative correlation was found between the ECV and RS (r=−0.31 to −0.41; all p values <0.05). In a patient-based analysis, there were significant positive correlations between the ECV and CS (r=0.45, p<0.001), ECV and LS from 2-chamber view (r=0.30, p=0.006), ECV and LS from 4-chamber view (r=0.37, p<0.001). There was a significant negative correlation between the ECV and RS (r=−0.43, p<0.001) (FIGURE) Conclusions In NIDCM patients, severity of myocardial fibrosis evaluated by T1 mapping is associated with impaired myocardial strain by FT technique. Correlation between the ECV and strain Funding Acknowledgement Type of funding source: None

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Diffuse myocardial fibrosis in early forms of dilated cardiomyopathy: insights from T1 mapping cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-15-s1-p147 ◽

2013 ◽

Vol 15 (S1) ◽

Author(s):

Fabian aus dem Siepen ◽

Sebastian A Seitz ◽

Mohamed A Abdelrazek ◽

Evangelos Giannitsis ◽

Hugo A Katus ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Dilated Cardiomyopathy ◽

Myocardial Fibrosis ◽

T1 Mapping ◽

Diffuse Myocardial Fibrosis

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OP0128 Detection of sub-clinical diffuse myocardial fibrosis by native t1 mapping magnetic resonance imaging in a prospective systemic sclerosis cohort

10.1136/annrheumdis-2017-eular.4955 ◽

2017 ◽

Author(s):

V Poindron ◽

E Chatelus ◽

M Canuet ◽

P Germain ◽

S El Ghannudi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Systemic Sclerosis ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

T1 Mapping ◽

Diffuse Myocardial Fibrosis ◽

Resonance Imaging ◽

Native T1

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

10.21203/rs.3.rs-60141/v1 ◽

2020 ◽

Author(s):

Naja Dam Mygind ◽

Signe Holm Nielsen ◽

Marie Mide Michelsen ◽

Adam Pena ◽

Daria Frestad Bechsgaard ◽

...

Keyword(s):

Coronary Artery Disease ◽

Extracellular Matrix ◽

Cardiac Magnetic Resonance ◽

Coronary Artery ◽

Myocardial Fibrosis ◽

T1 Mapping ◽

Obstructive Coronary Artery Disease ◽

Extracellular Volume ◽

Diffuse Myocardial Fibrosis ◽

Artery Disease

Abstract Background Women with angina and no obstructive coronary artery disease have an unfavourable prognosis, possibly due to coronary microvascular disease and diffuse myocardial fibrosis. In diffuse myocardial fibrosis myocardial extracellular matrix proteins, including the proteoglycans biglycan and versican are actively remodeled by matrix metalloproteinase. We investigated MMP-mediated degradation of biglycan and versican in women with possible DMF assessed by cardiac magnetic resonance T1 mapping. Methods Seventy-one women with angina pectoris and a coronary angiogram with no significant obstructive coronary artery disease (< 50% stenosis) were included. Asymptomatic age-matched women served as controls (n = 32). Matrix metalloproteinase 12 generated neo-epitope fragment of versican (VCANM) and MMP-9 generated fragment of biglycan (BGM) were measured in serum by specific competitive enzyme-linked immunosorbent assays (ELISAs). T1 mapping was performed by cardiac magnetic resonance with gadolinium (0.1 mmol/kg) using a look-locker pulse sequencing measuring T1 and extracellular volume. Results Both BGM and VCANM levels were higher in symptomatic women compared with controls; 31.4 ng/mL vs. 16.4 ng/mL (p < 0.001) and 2.1 ng/mL vs. 1.8 ng/mL (p < 0.001), respectively. Both BGM and VCANM were moderately correlated to global extracellular volume (r2 = 0.38, p < 0.001 and r2 = 0.26, p = 0.015 respectively). Conclusion Turnover of BGM and VCANM was increased in symptomatic women compared to asymptomatic women and associated to extracellular volume, supporting a link between angina with no obstructive coronary artery disease and fibrotic cardiac remodeling. The examined biomarkers may prove to be suitable for monitoring active extracellular matrix remodeling.

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