Noncontrast myocardial <i>T</i><sub>1</sub> mapping using cardiovascular magnetic resonance for iron overload

Sado, Daniel; Maestrini, Viviana; Piechnik, Stefan K.; Banypersad, Sanjay M.; White, Steven K; Flett, Andrew; Robson, Matthew D; Neubauer, Stefan; Ariti, Cono; Arai, Andrew E.; Kellman, Peter; Yamamura, Jin; Schoennagel, Bjoern P.; Shah, Farrukh; Davis, Bernard A.; Trompeter, Sara; Walker, John M.; Porter, John B.; Moon, James

doi:10.1002/jmri.24727

Cited by 150 publications

(127 citation statements)

References 43 publications

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“…91,106,107 From a clinical perspective, T1 indices can support differentiation of the infiltrative hypertrophic phenocopies in suspected cardiac amyloid infiltration: normal T1 indices can virtually exclude the presence of amyloid disease. On the contrary, significantly raised T1 indices point toward HCM or cardiac amyloid, 84,87,89 whereas low T1 values might raise the prospect of Fabry's disease in the appropriate setting.…”

Section: T1 Mapping In Hypertrophic Phenotypesmentioning

confidence: 99%

“…11,45,[83][84][85][86] Abnormal T1-mapping indices were also found in other common causes of DCM, including patients with cardiac amyloidosis, [87][88][89] diabetic cardiomyopathy, 34,90 and iron overload cardiomyopathies. 91 Native T1 mapping may also become of utility in patients with congenital heart disease and heart transplantation for rejection, 44,92,93 whose monitoring currently relies on repetitive invasive investigations. In a multicenter observational study, native T1 and ECV have been shown to be stronger predictors of poor outcome in DCM than classic parameters, 11 whereby native T1 was the strongest independent predictor of all-cause mortality and development of HF LGE− 27±3 0.6…”

Section: T1 Mapping In Nonischemic Dilative Cardiomyopathymentioning

confidence: 99%

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T1 Mapping in Characterizing Myocardial Disease

Püntmann

Peker

Chandrashekhar

et al. 2016

Circulation Research

261

202

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Cardiovascular magnetic resonance provides insights into myocardial structure and function noninvasively, with high diagnostic accuracy and without ionizing radiation. Myocardial tissue characterization in particular gives cardiovascular magnetic resonance a prime role among all the noninvasive cardiovascular investigations. Late gadolinium enhancement imaging is an established method for visualizing replacement scar, providing diagnostic and prognostic information in a variety of cardiac conditions. Late gadolinium enhancement, however, relies on the regional segregation of tissue characteristics to generate the imaging contrast. Thus, myocardial pathology that is diffuse in nature and affecting the myocardium in a rather uniform and global distribution is not well visualized with late gadolinium enhancement. Examples include diffuse myocardial inflammation, fibrosis, hypertrophy, and infiltration. T1 mapping is a novel technique allowing to diagnose these diffuse conditions by measurement of T1 values, which directly correspond to variation in intrinsic myocardial tissue properties. In addition to providing clinically meaningful indices, T1-mapping measurements also allow for an estimation of extracellular space by calculation of extracellular volume fraction. Multiple lines of evidence suggest a central role for T1 mapping in detection of diffuse myocardial disease in early disease stages and complements late gadolinium enhancement in visualization of the regional changes in common advanced myocardial disease. As a quantifiable measure, it may allow grading of disease activity, monitoring progress, and guiding treatment, potentially as a fast contrast-free clinical application. We present an overview of clinically relevant technical aspects of acquisition and processing, and the current state of art and evidence, supporting its clinical use.

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Section: T1 Mapping In Hypertrophic Phenotypesmentioning

confidence: 99%

Section: T1 Mapping In Nonischemic Dilative Cardiomyopathymentioning

confidence: 99%

T1 Mapping in Characterizing Myocardial Disease

Püntmann

Peker

Chandrashekhar

et al. 2016

Circulation Research

261

202

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“…Such myocardial pathologies detectable by CMR include focal scarring of either ischemic or nonischemic origin, [32][33][34] diffuse fibrosis, 35 edema, 36,37 inflammation, 38 fatty infiltration, 39 or abnormal myocardial deposition of substances such as amyloid protein, [40][41][42] glycolipids, 43 and iron. 44,45 As mentioned above, the increased mass in LVH is not solely the result of an increased amount of normal tissue. In less common cases, hypertrophy may be related to abnormal myocardial deposition of glycolipids, iron or amyloid, which also may affect ECG.…”

Section: Cmr Assessment Of Lvh Beyond LV Massmentioning

confidence: 92%

Left Ventricular Hypertrophy: The Relationship between the Electrocardiogram and Cardiovascular Magnetic Resonance Imaging

Bachárová

2014

Noninvasive Electrocardiol

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Conventional assessment of left ventricular hypertrophy (LVH) using the electrocardiogram (ECG), for example, by the Sokolow-Lyon, Romhilt-Estes or Cornell criteria, have relied on assessing changes in the amplitude and/or duration of the QRS complex of the ECG to quantify LV mass. ECG measures of LV mass have typically been validated by imaging with echocardiography or cardiovascular magnetic resonance imaging (CMR). However, LVH can be the result of diverse etiologies, and LVH is also characterized by pathological changes in myocardial tissue characteristics on the genetic, molecular, cellular, and tissue level beyond a pure increase in the number of otherwise normal cardiomyocytes. For example, slowed conduction velocity through the myocardium, which can be due to diffuse myocardial fibrosis, has been shown to be an important determinant of conventional ECG LVH criteria regardless of LV mass. Myocardial tissue characterization by CMR has emerged to not only quantify LV mass, but also detect and quantify the extent and severity of focal or diffuse myocardial fibrosis, edema, inflammation, myocarditis, fatty replacement, myocardial disarray, and myocardial deposition of amyloid proteins (amyloidosis), glycolipids (Fabry disease), or iron (siderosis). This can be undertaken using CMR techniques including late gadolinium enhancement (LGE), T1 mapping, T2 mapping, T2* mapping, extracellular volume fraction (ECV) mapping, fat/water-weighted imaging, and diffusion tensor CMR. This review presents an overview of current and emerging concepts regarding the diagnostic possibilities of both ECG and CMR for LVH in an attempt to narrow gaps in our knowledge regarding the ECG diagnosis of LVH. Ann Noninvasive Electrocardiol 2014;19(6):524-533 noninvasive techniques; electrocardiography; cardiac MRIThe diagnosis of left ventricular hypertrophy (LVH) in clinical practice is a finding that requires the attention of the clinician. It has been documented that LVH detected by echocardiography or the electrocardiogram (ECG) is a risk factor for cardiac morbidity or mortality which is independent of other known risk factors including blood pressure and left ventricular mass. 1-3In hypertensive patients, the finding of LVH in a patient has a direct impact on therapy. LVH detected by both echocardiography and ECG define target organ damage, and according to the European Society of Cardiology guidelines 4 the Address for correspondence : Ljuba Bacharova, M.D., D.S.c., M.B.A., International Laser Center, Ilkovicova 3, 841 presence of target organ damage is a key factor in the management of the hypertensive patient. It has also been shown that antihypertensive therapy decreases signs of LVH by echocardiography or ECG that are associated with improvement of the clinical status and prognosis of a hypertensive patient, [5][6][7] and thus the benefit of antihypertensive therapy can be monitored. However, these straightforward statements lead to a number of unanswered questions.It has repeatedly been documented that the diagnostic perform...

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“…This technique has been validated against pathology and represents the currently used gold standard for the non-invasive assessment of iron overload [91]. However, myocardial T1 mapping shows the potential for improved detection of mild iron loading, and its superior reproducibility has potential implications for clinical trial design and therapeutic monitoring [92]. Finally, ECV is significantly increased in thalassemia major and is associated with myocardial iron overload, as assessed by T2* [93].…”

Section: Iron Overload Diseasementioning

confidence: 99%

T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

Mavrogeni

Apostolou²,

Argyriou³

et al. 2017

Cardiology

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The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing.

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Noncontrast myocardial T₁ mapping using cardiovascular magnetic resonance for iron overload

Abstract: Myocardial T1 mapping is an alternative method for cardiac iron quantification. T1 mapping shows the potential for improved detection of mild iron loading. The superior reproducibility of T1 has potential implications for clinical trial design and therapeutic monitoring.

Cited by 150 publications

References 43 publications

T1 Mapping in Characterizing Myocardial Disease

T1 Mapping in Characterizing Myocardial Disease

Left Ventricular Hypertrophy: The Relationship between the Electrocardiogram and Cardiovascular Magnetic Resonance Imaging

T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

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Noncontrast myocardial T1 mapping using cardiovascular magnetic resonance for iron overload

Abstract: Myocardial T1 mapping is an alternative method for cardiac iron quantification. T1 mapping shows the potential for improved detection of mild iron loading. The superior reproducibility of T1 has potential implications for clinical trial design and therapeutic monitoring.

Cited by 150 publications

References 43 publications

T1 Mapping in Characterizing Myocardial Disease

T1 Mapping in Characterizing Myocardial Disease

Left Ventricular Hypertrophy: The Relationship between the Electrocardiogram and Cardiovascular Magnetic Resonance Imaging

T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

Contact Info

Product

Resources

About

Noncontrast myocardial T₁ mapping using cardiovascular magnetic resonance for iron overload