Histogram Analysis of Native T1 Mapping and Its Relationship to Left Ventricular Late Gadolinium Enhancement, Hypertrophy, and Segmental Myocardial Mechanics in Patients With Hypertrophic Cardiomyopathy

2018 ◽  
Vol 49 (3) ◽  
pp. 668-677 ◽  
Author(s):  
Chong-Wen Wu ◽  
Rui Wu ◽  
Ruo-Yang Shi ◽  
Dong-Aolei An ◽  
Bing-Hua Chen ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Histogram Analysis ◽  
Gadolinium Enhancement ◽  
Myocardial Mechanics ◽  
Native T1

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.

scholarly journals Effects of candesartan on left ventricular hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Maqsood ◽  
H.A Shakeel ◽  
H.F Shoukat ◽  
M.D Khan ◽  
S.A.Y Shah ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Interstitial Fibrosis ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Funding Source ◽  
Gadolinium Enhancement ◽  
Percent Change ◽  
Lv Mass ◽  
Significant Difference

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular (LV) hypertrophy in the absence of pressure overload. Manifestations of the disease include heart failure associated with diastolic dysfunction and atrial and ventricular tachyarrhythmias. Pathological features of HCM include myocyte hypertrophy, interstitial fibrosis, and myocyte disarray and are mediated by angiotensin II. Purpose This study aimed to evaluate the effects of candesartan on left ventricular (LV) hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy (HCM). Methods In double-blind fashion, 30 patients (6 women, 24 men; age: 55±11 years) with HCM were randomly assigned to receive placebo (n=13) or candesartan 50 mg twice a day (n=17) for 1 year. To measure LV mass and extent of fibrosis, cardiac magnetic resonance imaging was performed at baseline and 1 year as assessed by late gadolinium enhancement. Results There was a trend toward a significant difference in the percent change in LV mass (median: +5% with placebo vs. −5% with candesartan; p=0.06). There was a significant difference in the percent change in the extent of late gadolinium enhancement, with the placebo group experiencing a larger increase (+30±27% with placebo vs. −22±44% with candesartan; p=0.03). Conclusion Our study concludes reduction of the progression of myocardial hypertrophy and fibrosis with candesartan in patients with hypertrophic cardiomyopathy. Our study population was limited so we warrant larger trials to confirm a place for angiotensin receptor blockers in the management of patients with hypertrophic cardiomyopathy. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): Self funding

scholarly journals P0254MYOCARDIAL TISSUE CHARACTERIZATION IN LIVING KIDNEY DONORS 5 YEARS AFTER NEPHRECTOMY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anna Price ◽  
Victoria Stoll ◽  
Ravi Vijapurapu ◽  
Kirsty McGee ◽  
Roman Wesolowski ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
T1 Mapping ◽  
Cardiac Fibrosis ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Gadolinium Enhancement ◽  
Post Contrast ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Lv Mass

Abstract Background and Aims Uraemic cardiomyopathy is characterized by left ventricular (LV) hypertrophy, diastolic dysfunction and myocardial fibrosis. Diffuse interstitial fibrosis of the myocardium, assessed using cardiac magnetic resonance imaging (CMR) techniques of native T1-mapping and extracellular volume (ECV), has been demonstrated in end stage chronic kidney disease (CKD) and in patients with stage 3 CKD and normal left ventricular mass. In living kidney donors estimated glomerular filtration rate (eGFR) declines by a third after donation, with 60% having a resultant eGFR comparable with stage 3 CKD. Recent studies have demonstrated small increases in LV mass at 12 months after donation as well as functional sequelae of reduced global circumferential strain and apical torsion. We sought to establish whether living kidney donors had CMR evidence of diffuse interstitial cardiac fibrosis which might contribute to observed functional correlates. Method A cross sectional blinded study of living kidney donors (n=50) and healthy controls (n=45) who underwent 3 Tesla CMR and blood samples for biomarkers of fibrosis. A modified look-locker inversion recovery (MOLLI) 5(3)3 sampling scheme was used for T1 mapping followed by T2 mapping sequences at the mid LV slice. Five minutes after the administration of gadolinium (Gadovist®) contrast (0.15mmol/kg), standard T1-weighted gradient echo inversion recovery images were repeated for the assessment of late gadolinium enhancement (assessment for focal fibrosis). Post contrast MOLLI images were acquired using identical slice positions as native images using a 4(1)3(1)2 sampling scheme 15 minutes after the administration of gadolinium. Native and post contrast T1 time was used to calculate ECV. Results There were no differences in demographics between groups; age (donors 54 ± 12yrs vs. healthy controls 50 ± 13yrs, p=0.128), ethnicity (89% Caucasian) or male gender (37%). LV mass and volumes were not significantly different. Forty four donors and 34 controls consented to receive gadolinium contrast. Native T1 in the septal mid LV slice was not significantly different between groups (donors 1223 ± 35ms vs. controls 1210 ± 36ms, p=0.102). There was also no difference in T2 time of the septal mid LV slice (donors 40 ± 2ms vs. controls 40 ± 4ms vs. p=0.455). Late gadolinium enhancement was seen in five living kidney donors in a right ventricular insertion point pattern but there was no mid wall or ischaemic pattern enhancement. There was no difference in septal ECV at the mid LV slice (donors 25 ± 2% vs. controls 25 ± 2%, p=0.896). There was also no corresponding difference in fibroblast growth factor-23 (RU/ml) in donors 74 [58-105] vs. controls 59 [47-75], p=0.081 or soluble α-klotho (pg/ml) in donors 610 [503-810] vs. controls 703 [550-955], p=0.061. Conclusion Septal T1 times and ECV in living kidney donors at 5 years from donation are no different from healthy controls. Biomarkers of cardiac fibrosis are also comparable to healthy controls in this small cohort. We found no CMR evidence of the ultrastructural changes reported in uraemic cardiomyopathy in the hearts of living kidney donors at 5 years from donation.

scholarly journals Cardiovascular magnetic resonance for early detection of late cardiotoxicity in asymptomatic survivors of hodgkin and non-hodgkin lymphoma

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
N Van Der Velde ◽  
CPM Janus ◽  
DJ Bowen ◽  
HC Hassing ◽  
I Kardys ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Gadolinium Enhancement ◽  
Native T1 ◽  
Late Cardiotoxicity

Abstract Funding Acknowledgements Type of funding sources: None. Background Long-term survivors of Hodgkin (HL) and non-Hodgkin (NHL) lymphomas experience late adverse effects of mediastinal radiotherapy and/or anthracycline containing chemotherapy, which lead to premature cardiovascular morbidity and mortality. It is unknown whether early stages of myocardial dysfunction and heart failure in these survivors can be detected by cardiovascular magnetic resonance imaging (CMR). Purpose To identify early sensitive markers for the detection of subclinical late cardiotoxicity using CMR in asymptomatic survivors of HL and (primary mediastinal large B-cell lymphoma) NHL. Methods For this prospective observational study, we included 80 HL or selected NHL survivors, who have been free of disease for ≥5 years and were treated with mediastinal radiotherapy (RT) with/without chemotherapy. Patients with known cardiac disease were excluded. Included patients were compared to 40 age- and sex matched healthy controls. CMR included 1) cine imaging for assessment of left ventricular (LV) and right ventricular (RV) dimensions, systolic function and strain; 2) 2-dimensional late gadolinium enhancement (LGE) imaging; 3) T2 mapping and 4) pre- and post-contrast T1 mapping (MOLLI) for assessment of native T1 values and extracellular volume (ECV). Results Of the 80 patients, 78 (98%) had a history of HL and 2 (2%) of NHL with a mean age of 47 ± 11 years (46% male). All patients were treated with mediastinal RT which was combined with anthracycline containing chemotherapy in 68 (85%) patients. The median interval between diagnosis and CMR was 20 [14 – 26] years. Differences in CMR characteristics between patients and healthy controls are shown in the table. LV end-systolic volume was statistically significantly higher, but LV ejection fraction and mass were significantly lower in patients compared to healthy controls. RV volumes were significantly lower in patients, but RV ejection fraction was preserved. Strain parameters of the LV, i.e. global longitudinal strain, global circumferential strain and global radial strain, were slightly but significantly reduced in patients. No significant differences were found in myocardial T2 times and ECV; however, native myocardial T1 time was significantly higher in patients compared to healthy controls. LGE was detected in 25% of the patients and in the majority of patients with LGE this was classified as hinge point fibrosis. Conclusion Asymptomatic survivors of HL and NHL are not exempt of late cardiotoxicity, which can be detected by subtle changes in LV myocardial function, strain and native T1 value with CMR. Furthermore, late gadolinium enhancement was present in 25% of the patients. Further longitudinal studies are needed to assess the implication of these changes in relation to clinical outcome.

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

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