Abstract
BackgroundThis study aimed to determine native T1 and extracellular volume fraction (ECV) in distinct types of myocardial disease, including amyloidosis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), myocarditis and coronary artery disease (CAD), compared to controls.Methods We retrospectively enrolled patients with distinct types of myocardial disease, CAD patients, and control group (no known heart disease and negative CMR study) who underwent 3.0 Tesla CMR with routine T1 mapping. The region of interest (ROI) was drawn in the myocardium of the mid left ventricular (LV) short axis slice and at the interventricular septum of mid LV slice. ECV was calculated by actual hematocrit (Hct) and synthetic Hct. T1 mapping and ECV was compared between myocardial disease and controls, and between CAD and controls. Diagnostic yield and cut-off values were assessed.ResultsA total of 1188 patients were enrolled. The average T1 values in the control group were 1304 ± 42 ms at septum, and 1294 ± 37 ms at mid LV slice. The average T1 values in patients with myocardial disease and CAD were significantly higher than in controls (1441 ± 72, 1349 ± 59, 1345 ± 59, 1355 ± 56, and 1328 ± 54 ms for septum of amyloidosis, DCM, HCM, myocarditis, and CAD). Native T1 of the mid LV level and ECV at septum and mid LV with actual and synthetic Hct of patients with myocardial disease or CAD were significantly higher than in controls.ConclusionsAlthough native T1 and ECV of patients with cardiomyopathy and CAD were significantly higher than controls, the values overlapped. The greatest clinical utilization was found for the amyloidosis group.
Highlights
Cardiac magnetic resonance (CMR) has been increasingly used for the assessment of patients with suspected or known heart disease
extracellular volume fraction (ECV) associated with the all-cause mortality and composite HF endpoints in non-ischemic cardiomyopathy (NICM) patients, using values derived from septal T1 measurements [8], and associated with composite endpoints of hospitalization for heart failure and cardiac death in HFpEF population, using T1 values derived from the whole segment of left ventricular (LV) [9]
The results showed that adding ECV to native T1 significantly increased diagnostic sensitivity of dilated cardiomyopathy (DCM) and coronary artery disease (CAD) but not significantly increased for amyloidosis, hypertrophic cardiomyopathy (HCM) and myocarditis
Summary
Cardiac magnetic resonance (CMR) has been increasingly used for the assessment of patients with suspected or known heart disease. The extracellular volume fraction (ECV), which represents percentages of extracellular space of the myocardial tissue, can be derived from pre- and post-contrast T1 values of myocardium and blood pool in combination with hematocrit (Hct) using the established formula [5]. An increased ECV value indicates the presence of excessive collagen deposition or fibrosis, such as in amyloidosis or myocardial infarction [6]. Meta-analysis of six studies reported that cardiovascular disease patients including NICM, amyloidosis, and small amount of CAD, who have an increase in ECV value had a significantly higher incidence of cardiovascular death and combined cardiac events [10]. This study aimed to determine native T1 and extracellular volume fraction (ECV) in distinct types of myocardial disease, including amyloidosis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), myocarditis and coronary artery disease (CAD), compared to controls
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