Native T1 and T2 provide distinctive signatures in hypertrophic cardiac conditions – Comparison of uremic, hypertensive and hypertrophic cardiomyopathy

Abstract

Profound left ventricular (LV) hypertrophy with diastolic dysfunction and heart failure is the cardinal manifestation of heart remodelling in chronic kidney disease (CKD). Previous studies related increased T1 mapping values in CKD with diffuse fibrosis. Native T1 is a non-specific readout that may also relate to increased intramyocardial fluid. We examined concomitant T1 and T2 mapping signatures and undertook comparisons with other hypertrophic conditions. Methods: In this prospective multicentre study, consecutive CKD patients (n = 154) undergoing routine clinical cardiac magnetic resonance (CMR) imaging were compared with patients with hypertensive (HTN, n = 163) and hypertrophic cardiomyopathy (HCM, n = 158), and normotensive controls (n = 133). Results: Native T1 was significantly higher in all patient groups, whereas native T2 in CKD only (p b 0.001 vs. all groups). Native T1 and T2 were interrelated in patient groups and the strength of association was conditionspecific (CKD r = 0.558, HTN r = 0.324, both p b 0.001; HCM r = 0.157, p = 0.05). Native T1 and T2 were similarly correlated in all CKD stages (S3 r = 0.501, S4 0.586, S5 r = 0.424, p b 0.001 for all). Native T1 was the strongest myocardial discriminator between patients and controls (area under the curve, AUC HCM: 0.97; CKD: 0.97, HTN 0.98), native T2 between CKD vs HCM (AUC 0.90) and native T1 and T2 between CKD vs HTN (AUC: 0.83 and 0.80 respectively), p b 0.001 for all. Conclusions: Our findings reveal different CMR signatures of common hypertrophic cardiac phenotypes. Native T1 was raised in all conditions, indicating the presence of pathologic hypertrophic remodelling. Markedly raised native T2 was CKD-specific, suggesting a prominent role of intramyocardial fluid.

T1T2 Mapping and Texture Analysis of Cine and T2-weighted Magnetic Resonance Imaging to Detect Myocardial Tissue Changes Associated with Chronic Kidney Disease

“…Both T1 and T2 values of the septal myocardium were prolonged in the patients with CKD compared with controls. Previous studies have reported similar results 8-10, 12,13 , and these may be related to myocardial brosis, cardiomyocytes swelling, and interstitial edema 4,18,19 . Some underlying diseases of CKD, such as hypertension and diabetes mellitus, could affect the myocardial T1 or T2 values 12,20,21 .…”

“…Some underlying diseases of CKD, such as hypertension and diabetes mellitus, could affect the myocardial T1 or T2 values 12,20,21 . One previous study has shown that T2 values in the patients with CKD and myocardial hypertrophy are greater than those of hypertrophied myocardium in patients with hypertensive cardiomyopathy 12 . This nding indicates that the greater T2 values may mainly re ect cardiomyopathy induced by CKD, but not that associated with underlying diseases.…”

“…Late gadolinium enhancement (LGE) MRI and extracellular volume measurement using pre-and postcontrast T1 mapping are powerful methods for this purpose, including uremic cardiomyopathy [6][7][8] ; however, gadolinium-based contrast agents are contraindicated those with CKD at an advanced stage. T1 and T2 mapping MRI quantify the myocardial tissue changes associated with CKD without use of gadolinium [8][9][10][11][12][13] . Either T1 or T2 value is prolonged in CKD, and T2 mapping is useful for differentiating the cardiomyopathy induced by CKD from the normal myocardium and hypertrophied myocardium in patients with hypertensive cardiomyopathy or hypertrophic cardiomyopathy 10,12 .…”

Incremental Values of T1 Mapping in the Prediction of Sudden Cardiac Death Risk in Hypertrophic Cardiomyopathy: A Comparison With Two Guidelines

“…This is particularly important in our study because quite a few patients are over 60 years and more related with the adverse outcome caused by heart failure ( 37 ). Alternatively, native T1 mapping is a robust biomarker indicating the pathologic hypertrophic remodeling in HCM ( 38 , 39 ). The myocardial tissue remodeling including cardiomyocyte disarray is also a risk factor for malignant arrhythmia ( 15 , 32 , 40 ).…”

Role of CMR Mapping Techniques in Cardiac Hypertrophic Phenotype

“…In support of the concept of T1 mapping capability to look “deep” into the myocardium, a recent study by Wang et al showed that newly-developed radiomic analysis of native T1 values could differentiate between HCM induced by mutation of MYH7 (β-myosin heavy chain) or MYBPC3 (β-myosin-binding protein C), the most commonly affected genes, with good discrimination [ 47 ]. Anyway, it must be underlined how entity and distribution of increase of native T1 mapping does not always allow to differentiate between HCM and other myocardial disease, suggesting that mapping techniques should be merged with clinical, morphological and LGE information to be correctly interpreted [ 48 , 49 ].…”