Novel cardiac nuclear magnetic resonance method for noninvasive assessment of myocardial fibrosis in hemodialysis patients

Graham-Brown, Matthew P M; March, Daniel S.; Churchward, Darren R; Stensel, David J.; Singh, Anvesha; Arnold, Jayanth R.; Burton, James O.

doi:10.1016/j.kint.2016.07.014

Cited by 68 publications

(97 citation statements)

References 47 publications

(55 reference statements)

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“…Although these authors found no differences in native T1 at the segmental level (in contrast to Graham-Brown et al [35]), a correlation was observed between septal native T1 and clinical parameters (troponin level and corrected QT interval). An important finding of the study featured the demonstration of a significant correlation between native T1 and LVMi (global T1: R=0.452, p= 0.008, septal T1 R=0.449, p= 0.009, midseptal T1 R=0.498 p= 0.003 respectively).…”

Section: Assessment Of the Myocardium Without Contrast Agent In Ckd Pmentioning

confidence: 62%

“…In 2016, Graham-Brown et al and Rutherford et al [35,36] published promising results in dialysis populations using native T1 as a novel CMR technique. Not only were the studies conducted in parallel, but both groups also used the same methodology.…”

Section: Assessment Of the Myocardium Without Contrast Agent In Ckd Pmentioning

confidence: 99%

“…Elevated global T1 levels were correlated with global strain parameters while septal native T1 was correlated with septal systolic strain. Graham-Brown et al not only presented the possibility of non-invasive T1 mapping in a haemodialysis population, but also suggested that the interventricular septum is the most sensitive region with regard to the development of myocardial fibrosis [35].…”

Section: Assessment Of the Myocardium Without Contrast Agent In Ckd Pmentioning

confidence: 99%

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Cardiac Magnetic Resonance Imaging of the Myocardium in Chronic Kidney Disease

Kis

Ablonczy

Reusz

2018

Kidney Blood Press Res

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Early stages of chronic kidney disease (CKD) are often underdiagnosed, while their deleterious effects on the cardiovascular (CV) system are already at work. Thus, the assessment of early CV damage is of crucial importance in preventing major CV events. Myocardial fibrosis is one of the major consequences of progressive CKD, as it may lead to reentry arrhythmias and longterm myocardial dysfunction predisposing to sudden death and/or congestive heart failure. Subclinical myocardial fibrosis, with a potential key role in the development of uraemic cardiac disease, can be measured and characterised by appropriate cardiac magnetic resonance (CMR) techniques. Fibrosis detection was initially based on the contrast agent gadolinium, due to the superiority in sensitivity and accuracy of contrast-based methods in fibrosis assessment relative to native techniques. However, the severe consequences of gadolinium administration in uraemia (nephrogenic systemic fibrosis) have forced practitioners to re-evaluate the methodology. In the present overview, we review the possible contrast-based and contrast agent-free CMR techniques, including native T1 relaxation time, extracellular volume and global longitudinal strain measurement. The review also summarises their potential clinical relevance in CKD patients based on recently published studies. Cardiovascular disorder in chronic kidney diseaseChronic kidney disease (CKD) is a common cardiovascular (CV) risk factor. Early stages of CKD are often underdiagnosed, whereas their deleterious effects on the cardiovascular system are already at work. According to the large meta-analysis by the Chronic Kidney Disease Prognosis Consortium, the slow, gradual increase in cardiovascular risk is already present in CKD patients at 60-75 ml/min/1.73m² glomerular filtration rates [1], with CKD

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Section: Assessment Of the Myocardium Without Contrast Agent In Ckd Pmentioning

confidence: 62%

Section: Assessment Of the Myocardium Without Contrast Agent In Ckd Pmentioning

confidence: 99%

Section: Assessment Of the Myocardium Without Contrast Agent In Ckd Pmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac Magnetic Resonance Imaging of the Myocardium in Chronic Kidney Disease

Kis

Ablonczy

Reusz

2018

Kidney Blood Press Res

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“…Measurement of LV dimensions is reproducible in HD patients [24,25] and the graded relationship between LV mass and cardiovascular risk [26] underlines the importance of accurately quantifying LV structure in clinical trials involving HD patients. The multi-parametric nature of CMR means it can give detailed information about myocardial tissue characterization, particularly myocardial fibrosis, without the need for gadolinium-based contrast agents, which are contraindicated in patients with advanced renal disease [27,28,29]. Native T1 mapping is a novel, non-contrast CMR measure that correlates well with histological levels of myocardial fibrosis in patients with aortic stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Native T1 mapping is a novel, non-contrast CMR measure that correlates well with histological levels of myocardial fibrosis in patients with aortic stenosis. Our group and others have shown it is significantly raised in HD patients compared to controls [28,29] and its outstanding reproducibility makes it an attractive biomarker for the assessment of myocardial fibrosis in dialysis patients [27]. …”

Section: Introductionmentioning

confidence: 99%

Cardiac Remodelling in Patients Undergoing in-Centre Nocturnal Haemodialysis: Results from the MIDNIGHT Study, a Non-Randomized Controlled Trial

Graham-Brown¹,

Churchward

Hull

et al. 2017

Blood Purif

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Evidence suggests extended-hours haemodialysis (HD) may improve cardiovascular, medical and quality-of-life outcomes. In-centre nocturnal haemodialysis (INHD) is an established but underutilized method of providing extended-hours treatment. This 6-month, non-randomized controlled trial (ISRCTN16672784) recruited 13 INHD patients and 12 control patients on conventional HD. The effects of treatment on left ventricular (LV) structure, function and myocardial fibrosis were assessed using cardiac magnetic resonance imaging and native T1 mapping. Quality-of-life and clinical measures were also collected. INHD led to significant reductions in LV mass (-14.75 vs. +6.54 g; p = 0.02), global T1 (-30.62 vs. 0.4 ms; p = 0.05) and non-septal native T1 values (-30.93 vs. 8.96 ms; p = 0.02) over time. There were also significant improvements in serum phosphate (-0.39 vs. +0.02 mmol/L; p = 0.03) and reductions in ultrafiltration rates (-2.32 vs. +0.70 mL/h/kg p = 0.05) between INHD and controls. Six-months of INHD was associated with favourable LV remodelling and reduced myocardial fibrosis compared to patients on conventional haemodialysis.

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Texture Analysis of Native T1 Images as a Novel Method for Noninvasive Assessment of Uremic Cardiomyopathy

Zhou

et al. 2021

Magnetic Resonance Imaging

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Background: Noncontrast cardiac T 1 times are increased in dialysis patients which might indicate fibrotic alterations in uremic cardiomyopathy. Purpose: To explore the application of the texture analysis (TA) of T 1 images in the assessment of myocardial alterations in dialysis patients. Study Type: Case-control study. Population: A total of 117 subjects, including 22 on hemodialysis, 44 on peritoneal dialysis, and 51 healthy controls. Field Strength: A 3 T, steady-state free precession (SSFP) sequence, modified Look-Locker imaging (MOLLI). Assessment: Two independent, blinded researchers manually delineated endocardial and epicardial borders of the left ventricle (LV) on midventricular T 1 maps for TA. Statistical Tests: Texture feature selection was performed, incorporating reproducibility verification, machine learning, and collinearity analysis. Multivariate linear regressions were performed to examine the independent associations between the selected texture features and left ventricular function in dialysis patients. Texture features' performance in discrimination was evaluated by sensitivity and specificity. Reproducibility was estimated by the intraclass correlation coefficient (ICC). Results: Dialysis patients had greater T 1 values than normal (P < 0.05). Five texture features were filtered out through feature selection, and four showed a statistically significant difference between dialysis patients and healthy controls. Among the four features, vertical run-length nonuniformity (VRLN) had the most remarkable difference among the control and dialysis groups (144 AE 40 vs. 257 AE 74, P < 0.05), which overlap was much smaller than Global T 1 times (1268 AE 38 vs. 1308 AE 46 msec, P < 0.05). The VRLN values were notably elevated (cutoff = 170) in dialysis patients, with a specificity of 97% and a sensitivity of 88%, compared with T 1 times (specificity = 76%, sensitivity = 60%). In dialysis patients, VRLN was significantly and independently associated with left ventricular ejection fraction (P < 0.05), global longitudinal strain (P < 0.05), radial strain (P < 0.05), and circumferential strain (P < 0.05); however, T 1 was not.

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Novel cardiac nuclear magnetic resonance method for noninvasive assessment of myocardial fibrosis in hemodialysis patients

Cited by 68 publications

References 47 publications

Cardiac Magnetic Resonance Imaging of the Myocardium in Chronic Kidney Disease

Cardiac Magnetic Resonance Imaging of the Myocardium in Chronic Kidney Disease

Cardiac Remodelling in Patients Undergoing in-Centre Nocturnal Haemodialysis: Results from the MIDNIGHT Study, a Non-Randomized Controlled Trial

Texture Analysis of Native T1 Images as a Novel Method for Noninvasive Assessment of Uremic Cardiomyopathy

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