MRI T1 Mapping in Hypertrophic Cardiomyopathy: Evaluation in Patients Without Late Gadolinium Enhancement and Hemodynamic Obstruction

Abstract

Background:The value of native myocardial T1 mapping and extracellular volume (ECV) fraction in patients who have hypertrophic cardiomyopathy (HCM) but no late gadolinium enhancement (LGE) and no hemodynamic obstruction are currently unknown.Purpose: To evaluate myocardial fibrosis in patients with nonobstructive HCM and no LGE by using native myocardial T1 mapping and ECV fraction and to study their relationships to left ventricular (LV) function and LV hypertrophy. Materials and Methods:Patients with HCM who underwent cardiac MRI between 2012 and 2015 were retrospectively evaluated. Patients were included if they had no LGE at MRI, LV ejection fraction greater than or equal to 45%, and no LV outflow tract obstruction. Healthy participants had similar age and sex distribution. Native myocardial T1 and ECV were measured with MRI.Results: A total of 258 patients with HCM (mean age 6 standard deviation, 49 years 6 15; 74% men) and 122 healthy participants (mean age, 50 years 6 14; 76% men) were evaluated. Native myocardial T1 was longer and ECV fraction was higher in the patients with HCM relative to the healthy participants (mean native T1, 950 msec 6 48 vs 913 msec 6 46; mean ECV, 24.5% 6 2.8 vs 23.0% 6 2.7; both P , .001). Maximum T1 and ECV values correlated strongly with LV mass index for the entire patient cohort with HCM (both r = 0.86; P , .001) and for the subgroups (r = 0.86 and 0.85 for interventricular septal group and r = 0.88 and 0.86 for apical group; all P , .001). Conclusion:Prolonged myocardial T1 and elevated extracellular volume in hypertrophic cardiomyopathy suggests diffuse myocardial fibrosis, even in the absence of regionally apparent late gadolinium enhancement and hemodynamic obstruction, and is associated with left ventricular hypertrophy.

Aldosterone-induced cardiac damage in primary aldosteronism depends on its subtypes

“…Past studies reported that T1 values played a role for discriminating cardiac events and prognosis in some cardiomyopathies. [28][29][30] with primary aldosteronism (PA), who underwent both adrenal venous sampling (AVS) and cardiac magnetic resonance (CMR), were included. Fourteen patients were excluded due to previous history of cardiac events (heart failure, ischemic heart disease, cardiomyopathy, congenital heart disease, or arrhythmia) or severe renal dysfunction (estimated glomerular filtration rate < 30 ml/min).…”

Native T1 mapping in diffuse myocardial diseases using 3-Tesla MRI: An institutional experience

“…[ 23 27 ] Previous studies have demonstrated the ability of native T1 mapping to detect myocardial involvement in the subclinical stage of disease. [ 28 29 30 31 ] Native T1 mapping is thus a technique which noninvasively samples the myocardium, making it a promising alternative to invasive myocardial biopsy and LGE imaging. Postcontrast T1 mapping can also be done after administration of intravenous Gadolinium-based contrast agent and is sensitive in detection of diffuse myocardial fibrosis.…”

“…These include MOLLI, shortened modified Look-Locker inversion recovery (ShMOLLI), saturation recovery single-shot acquisition (SASHA), and saturation pulse prepared heart-rate-independent inversion recovery (SAPPHIRE). [ 23 31 37 38 39 ] The most commonly used and the most evaluated method for T1 mapping is MOLLI. It uses 17 heartbeats with acquisition of 3-3-5 images and an interval of three heartbeats for recovery in between acquisitions.…”

Cardiovascular Magnetic Resonance Imaging and Heart Failure

“…The presence and extent of LGE on CMR is associated with ventricular tachyarrhythmias and SCD [ 67 , 95 , 96 ]. A recent study demonstrated native T1 and ECV elevation in patients with HCM in the absence of LGE, and follow-up data showed elevated T1 and ECV were associated with SCD [ 97 ].…”