Abstract 13596: Magnetic Resonance - Derived Pre-contrast T1 Relaxation Time is the Accurate Marker of Diffuse Myocardial Fibrosis in Severe Aortic Valve Disease: A Comparison With Left Ventricular Myocardial Biopsy

Introduction: Diffuse myocardial fibrosis (DFM) is the major mechanism in the pathophysiology of the aortic stenosis and its complications. DMF is detectable by magnetic resonance imaging (MRI) using the T1 mapping technique. Hypothesis: The MRI derived native T1 relaxation time and myocardial extracellular volume fraction (ECV) will be significantly related to the extent of DMF et targeted myocardial left ventricular (LV) biopsy. Methods: The study population consisted of 40 consecutive patients (age 63±8y, 65% males) undergoing surgery for severe aortic stenosis (77.5%), aortic root dilatation (7.5%) or valve regurgitation (15%). All patients underwent MRI-derived T1 mapping and 2D-, 3D speckle tracking-derived strain analysis prior to surgery. The T1 relaxation time was assessed in basal interventricular septum pre and 10 min post contrast administration using the modified Look-Locker Inversion recovery sequence. A LV myocardial biopsy specimen was obtained during surgery from basal interventricular septum under the guidance of the MRI operator to assure spatial concordance with the MRI assessment. The percentage of myocardial collagen was quantified as a ratio of Picrosirius Red-positive area over total sample area using the Image J. Results: The average percentage of myocardial collagen was 22 ± 14.8 %. The average native T1 relaxation time and ECV was 1010 ± 48 ms and 0.288 ± 0.055, respectively. Both native T1 relaxation time with cutoff value of ≥ 1010 ms (Ss=90%, Sp=73%, AUC =0.82) and ECV with cutoff value of ≥ 0.315 (Ss=80%, Sp=90%, AUC =0.85) showed high accuracy to identify extensive (> 30%) myocardial collagen content (Figure 1A, 1B). The native T1 mapping showed significant correlation with LV mass, 2D and 3D global longitudinal strain (all p<0.05) while the ECV did not (p=NS). Conclusions: Native T1 relaxation time is the accurate marker of diffuse myocardial fibrosis with the significant relationship with LV morphology and myocardial function.

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P1604 T1 mapping in asymptomatic patients with extracardiac sarcoidosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1022 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R Panovsky ◽

M Doubkova ◽

T Holecek ◽

J Machal ◽

V Feitova ◽

...

Keyword(s):

Relaxation Time ◽

Respiratory Tract ◽

T1 Mapping ◽

Left Ventricular ◽

T1 Relaxation Time ◽

Post Contrast ◽

Native T1 ◽

T1 Relaxation ◽

Asymptomatic Patients ◽

Molli Sequence

Abstract Funding Acknowledgements LQ1605 from the National Program of Sustainability II (MEYS CR) Introduction Sarcoidosis is a systemic granulomatous disease affecting in particular the respiratory tract. Estimated 5% of these patients have clinical symptoms of heart involvement. Real number of patients with cardiac sarcoidosis is thought to be higher (around 20-30%), because the granulomatous process is sometimes asymptomatic. Cardiac magnetic resonance (CMR) including T1 relaxation time measurement could potentially detect early asymptomatic stadia of sarcoidosis of the heart. Purpose The aim of this study was to assess T1 mapping in detection of early cardiac involvement in asymptomatic patients with sarcoidosis. Methods One hundred twenty patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis and without any heart disease history were included. One hundred thirteen of them underwent CMR examination at 3,0 MR scanner. Cine images for assessment of left ventricular (LV) volumetric and functional parameters, and pre- and post-contrast Saturation method using adaptive recovery times for cardiac T1 mapping (SMART1map) and Modified Look-Locker Inversion recovery (MOLLI) images were acquired for assessment of native T1 relaxation time and extracellular volume (ECV). The measured parameters were compared between sarcoidosis patients and 22 healthy controls. Results Sarcoidosis patients had not enlarged LV (end-diastolic volume 119 ± 24ml vs 97 ± 20ml, p = NS) and normal global and regional systolic LV function – LV ejection fraction (EF) 65 ± 5% vs 66 ± 7% (p = NS). Mean native T1 relaxation time was not prolonged - 1464 ± 93 msec vs 1482 ± 88msec (p = NS) measured by SMART1map and 1317 ± 60 msec vs 1313 ± 83msec (p = NS) measured using MOLLI sequence. Similarly, mean ECV value was not increased - 16,3 ± 3,4% vs 17,9 ± 3,7% (p = NS) measured by SMART1map and 30,9 ± 2,9msec vs 30,7 ± 5,0% (p = NS) measured using MOLLI sequence. Conclusion Myocardial native T1 relaxation time was not prolonged and ECV was not increased in asymptomatic patients with extracardiac sarcoidosis.

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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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Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –

Circulation Journal ◽

10.1253/circj.cj-15-1309 ◽

2016 ◽

Vol 80 (5) ◽

pp. 1202-1209 ◽

Cited By ~ 24

Author(s):

Radka Kockova ◽

Petr Kacer ◽

Jan Pirk ◽

Jiri Maly ◽

Lucie Sukupova ◽

...

Keyword(s):

Relaxation Time ◽

Volume Fraction ◽

Extracellular Volume ◽

Extracellular Volume Fraction ◽

Left Ventricular ◽

Diffuse Myocardial Fibrosis ◽

Heart Valve Disease ◽

Myocardial Biopsy ◽

T1 Relaxation Time ◽

T1 Relaxation

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

Circulation ◽

10.1161/circ.132.suppl_3.15137 ◽

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.

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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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