Myocardial T1 and extracellular volume fraction measurement in asymptomatic patients with aortic stenosis: reproducibility and comparison with age-matched controls

Singh, Anvesha; Horsfield, Mark A.; Bekele, Soliana; Khan, Jamal Nasir; Greiser, Andreas; McCann, Gerry P

doi:10.1093/ehjci/jev007

Cited by 68 publications

(49 citation statements)

References 24 publications

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“…This means that ECV markedly overestimates the degree of fibrosis early on, and differentiating patients from aged-matched controls may not be possible, as we have shown in asymptomatic patients with moderate and severe aortic stenosis. 8 Further work is also required to confirm that these findings are consistent in women, older athletes, those from sports other than running/cycling/triathlon, and ethnic backgrounds who may be more prone to adverse LV remodeling. Given that preparticipation screening for sports is controversial 20,21 and the high cost of CMR, widespread use in this situation is not indicated.…”

Section: Graham-brown and Mccann T1 Mapping In Athletesmentioning

confidence: 87%

“…Native (before contrast) and post-contrast T1 mapping allow quantification of myocardial extracellular volume (ECV), which correlates with diffuse interstitial fibrosis 7 and is highly robust and reproducible. 8 In addition, native T1 mapping, which reflects the water content of tissues, is a useful imaging tool in many disease states, particularly the diagnosis and monitoring of patients with cardiac amyloidosis. 9 More recently, native T1 mapping has been shown to potentially improve the ability of CMR to differentiate patients with early-stage dilated cardiomyopathy from physiological adaptation to exercise in veteran athletes with low-normal ejection fraction on echocardiography.…”

Section: See Article By Mcdiarmid Et Almentioning

confidence: 99%

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T1 Mapping in Athletes

Graham-Brown

McCann

2016

Circ: Cardiovascular Imaging

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Section: Graham-brown and Mccann T1 Mapping In Athletesmentioning

confidence: 87%

Section: See Article By Mcdiarmid Et Almentioning

confidence: 99%

T1 Mapping in Athletes

Graham-Brown

McCann

2016

Circ: Cardiovascular Imaging

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“…This has also been observed in other studies. 57,58,60 Although the prognostic value of extracellular volume fraction has been demonstrated in other patient Figure 5. To date, there are 4 different myocardial T1 mapping techniques used to assess diffuse interstitial fibrosis.…”

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confidence: 97%

“…Indeed, the role of myocardial T1 mapping has been well studied in aortic stenosis, with many studies demonstrating a correlation between this marker of diffuse fibrosis and aortic stenosis severity, left ventricular mass, and cardiac performance. [56][57][58][59][60] To date four different T1 mapping approaches have been investigated and validated against the extent of myocardial fibrosis on histology.56,61-66 Each has its own potential advantages and limitations ( Figure 5). In our experience, extracellular volume fraction, which corrects for blood pool and the plasma gadolinium volume of distribution, offers the best reproducibility (including scan-rescan repeatability) and the ability to differentiate patients from healthy volunteers.…”

mentioning

confidence: 99%

“…Despite its potential limitations, myocardial T1 mapping may still be useful in assessing treatment responses and disease progression because of its low scan-rescan variability and greater sensitivity. 59,60,69,70 Assessing Activity of Myocardial Fibrosis Similar to the relationship between 18 F-fluoride PET and CT calcium scoring, a marker of fibrosis activity would complement current assessments of fibrosis burden by cardiovascular magnetic resonance.6,29 18 F-Fluciclatide is a PET tracer that has a high affinity for extracellular integrin receptors, which are upregulated in regions of myocardial fibrosis. 71,72 Recently, we have demonstrated increased 18 F-fluciclatide activity in regions of previous myocardial infarction, and the potential of this radioactive tracer as marker of fibrosis activity in aortic stenosis is currently being investigated (ClinicalTrials.gov NCT01837160).…”

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confidence: 99%

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Risk Stratification in Patients With Aortic Stenosis Using Novel Imaging Approaches

Chin

Pawade

Newby

et al. 2015

Circ: Cardiovascular Imaging

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Downloaded from Chin et al Novel Imaging in Aortic Stenosisaortic stenosis. 19 Unfortunately, this 4-point score remains semiquantitative and limited by poor interobserver agreement.Electrocardiography-gated noncontrast computed tomography (CT) is able to provide more detailed information with respect to the density, volume, and mass of macroscopic calcium deposits within the aortic valve. CT calcium scoring of the valve is similar to the approach used in the coronary arteries and most commonly expressed as Agatston units (AU). Indeed, aortic valve CT calcium scoring demonstrates high intra, interobserver, and scan-rescan reproducibility (a limitation with the echocardiographic calcium score) 20,21 and correlates well with the calcium weight of excised valves 20 and other echocardiographic parameters of aortic stenosis severity. 17,[20][21][22] Interestingly, patients with more severe disease at baseline experienced more rapid progression of aortic valve calcification on CT ( Figure 1B), and multiple studies have also demonstrated a strong relationship between baseline calcium scores and the rate of subsequent disease progression. 16,17,23 CT calcium scoring of the aortic valve holds potential as an alternative assessment of aortic stenosis severity. Indeed, CT assessment holds several potential advantages over and above echocardiography, as it is independent from flow, geometric assumptions, and the presence of other cardiovascular conditions, such as hypertension and mitral regurgitation. Until recently, we lacked appropriate thresholds to differentiate patients with severe and nonsevere disease, thereby limiting the clinical utility of this technique.These thresholds were recently proposed in a multicenter study involving >600 patients with at least moderate aortic stenosis and preserved ejection fraction who had undergone both CT and echocardiography. Using sex-specific thresholds (men, ≥2065 AU or ≥476 AU/cm 2 when indexed to aortic annular area and women, ≥1274 AU or ≥292 AU/cm 2 ), aortic valve CT calcium score defined severe aortic stenosis with high accuracy (sensitivity, ≥86% and specificity, ≥79%). 24,25 Moreover, the prognostic effect of these calcium score thresholds was subsequently F-Fluoride ( 18 F-NaF; a marker of novel calcification) activity increased markedly with severity of aortic stenosis (AS). Conversely,18 F-fluorodeoxyglucose ( 18 F-FDG; a marker of inflammation) activity had a more modest association with AS severity. This supports the notion that calcification rather than inflammation predominates in the valve, particularly in the later stages of the disease. Furthermore, aortic valve CT calcium score is of particular clinical relevance in patients with discordant small aortic valve area and low mean pressure gradient where the true severity of the disease remains uncertain. This commonly affects up to a third of patients with moderate or severe disease and can be because of either low flow states (as a consequence of a depressed left ventricular ejection fraction or a small ventric...

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Interstudy repeatability of self‐gated quantitative myocardial perfusion MRI

Likhite

Suksaranjit

Adluru

et al. 2015

Magnetic Resonance Imaging

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Purpose To evaluate the inter-study repeatability of multi-slice quantitative cardiovascular magnetic resonance myocardial blood flow (MBF), myocardial perfusion reserve (MPR), and extracellular volume (ECV). A unique saturation recovery self-gated acquisition was used for the perfusion scans. Materials and Methods An ungated golden angle radial turboFLASH pulse sequence was used to scan 10 subjects on two separate days on a 3T scanner. A single saturation pulse was followed by a set of 4 slices. Rest and hyperemia scans were acquired during free breathing. The images were reconstructed using an iterative algorithm with spatiotemporal constraints. The ungated images were retrospectively binned (self-gated) into near-systole and near-diastole. Deformable registration was performed to adjust for respiratory and residual cardiac motion, and the data was fit with a Fermi model to estimate the inter-study repeatability of quantitative self-gated MBF and MPR. Results The coefficient of variation (CoV) of the territorial MPR using the self-gated near-systole data was 18.6%. The self-gated near-diastole data gave less good CoV of MPR, equal to 46.2%. For MBFs, and using smaller (segmental) regions, the CoVs were 20.1% and 22.7% for the estimation of myocardial blood flow at stress and rest respectively using the self-gated near-systole data. The self-gated near-diastole data gave CoV=48.6% and 44.9% for stress and rest. Conclusion The self-gated free breathing technique for quantification of myocardial blood flow showed good repeatability for near-systole, with results comparable to published studies on inter-study repeatability of quantitative myocardial perfusion MRI using ECG-gating and breath-holds. Self-gated near-diastole data results were less repeatable.

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Myocardial T1 and extracellular volume fraction measurement in asymptomatic patients with aortic stenosis: reproducibility and comparison with age-matched controls

Cited by 68 publications

References 24 publications

T1 Mapping in Athletes

T1 Mapping in Athletes

Risk Stratification in Patients With Aortic Stenosis Using Novel Imaging Approaches

Interstudy repeatability of self‐gated quantitative myocardial perfusion MRI

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