Histological validation of cardiac magnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis

Iles, Leah M.; Ellims, A.; Llewellyn, Huw; Hare, James L.; Kaye, David M.; McLean, Catriona; Taylor, Andrew J.

doi:10.1093/ehjci/jeu182

Cited by 216 publications

(146 citation statements)

References 24 publications

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“…Because of its ability to recognize subclinical diffuse myocardial involvement, as well as a measure of longitudinal changes of myocardial inflammation, T1 mapping seems promising for detecting subclinical pathophysiological changes, potentially allowing us to modify the course of disease. This is supported by histological data 45,51 on accumulation of diffuse fibrosis and the parallel relationships of T1 mapping with progressive ventricular remodeling and stiffness in DCM. 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.…”

Section: T1 Mapping In Nonischemic Dilative Cardiomyopathysupporting

confidence: 55%

“…35,41,42,47,50 The majority of studies relied on minute amounts of tissue from endomyocardial biopsy; explanted hearts were analyzed in only 2 studies. 44,51 Interestingly, the most recently reported association between CMR and histologically derived ECV (using a tissue-FAXS software analysis) 35 yielded an association of r=0.493 (P=0.002), demonstrating the influence of technical and myocardial elements on the measurement (Table 2). Histological evidence on other tissue correlates remains scarce.…”

Section: T1-mapping Indices: Initial Experience and Histological Corrmentioning

confidence: 94%

“…First, native T1 provides excellent positive and negative predictive values Types of sequences and a staining method used, as well as several patients included, are also reported. Discriminative focus on replacement versus interstitial fibrosis is a paramount factor influencing the diversity of observed relationships; whereas some authors steered away from the inclusion of replacement fibrosis/LGE affected areas in histological CVF (or accounted for them separately), 35,41,47,51 or all-inclusive. 44,45,49 CVF indicates collagen volume fraction; DCM, dilative cardiomyopathy; ECV, extracellular volume fraction; FLASH-IR, fast low angle shot-inversion recovery; GCA, gadolinium contrast agents; IHD, ischemic heart disease; MOLLI, modified LookLocker imaging; NICM, nonischemic cardiomyopathies; and VAST, variable temporal sampling of k-space.…”

Section: T1 Mapping In Myocardial Inflammationmentioning

confidence: 99%

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T1 Mapping in Characterizing Myocardial Disease

Püntmann

Peker

Chandrashekhar

et al. 2016

Circulation Research

270

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 Nonischemic Dilative Cardiomyopathysupporting

confidence: 55%

Section: T1-mapping Indices: Initial Experience and Histological Corrmentioning

confidence: 94%

Section: T1 Mapping In Myocardial Inflammationmentioning

confidence: 99%

See 1 more Smart Citation

T1 Mapping in Characterizing Myocardial Disease

Püntmann

Peker

Chandrashekhar

et al. 2016

Circulation Research

270

202

View full text Add to dashboard Cite

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“…However, one of the major advantages of CMR is the early detection of subclinical myocardial involvement in systemic disorders already in preserved ejection fraction. 15,16 CMR enables the differentiation of underlying myocardial injuries, including inflammation, 16 focal and diffuse fibrosis, 17 or fatty infiltration. 18,19 Similar morphological changes were described in DM2 in histological reports.…”

Section: See Editorial By Shah and Semigran See Clinical Perspectivementioning

confidence: 99%

Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction

Schmacht

Traber

Grieben

et al. 2016

Circ: Cardiovascular Imaging

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H magnetic resonance spectroscopy were performed. Extracellular volume fraction was calculated. Conduction abnormalities were diagnosed based on Groh criteria. LGE located subepicardial basal inferolateral was detectable in 22% of the patients. Extracellular volume was increased in this region and in the adjacent medial inferolateral segment (P=0.03 compared with healthy controls). In 21% of patients with DM2, fat deposits were detectable (all women). The control group showed no abnormalities. Myocardial triglycerides were not different in LGE-positive and LGE-negative subjects (P=0.47). Six patients had indicators for conduction disease (60% of LGE-positive patients and 12.5% of LGE-negative patients). Conclusions-In DM2, subclinical myocardial injury was already detectable in preserved left ventricular ejection fraction.

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“…11,[13][14][15][16][17] Interstitial fibrosis and the expansion of extracellular space in hypertension herald decompensation with eccentric remodeling and heart failure. [12][13][14][15][18][19][20][21][22] In this study, we investigated the ability of CMR to discern hypertrophic phenotypes based on detection of diffuse myocardial disease and regional fibrosis by myocardial T1 mapping and LGE, respectively, first, in overt LVH, and second, in phenotypically subexpressed HCM gene carriers. …”

mentioning

confidence: 99%

T1 Mapping in Discrimination of Hypertrophic Phenotypes: Hypertensive Heart Disease and Hypertrophic Cardiomyopathy

Hinojar

Varma

Child³

et al. 2015

Circ: Cardiovascular Imaging

222

141

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Background-The differential diagnosis of left ventricular (LV) hypertrophy remains challenging in clinical practice, in particular, between hypertrophic cardiomyopathy (HCM) and increased LV wall thickness because of systemic hypertension. Diffuse myocardial disease is a characteristic feature in HCM, and an early manifestation of sarcomeregene mutations in subexpressed family members (G+P− subjects). This study aimed to investigate whether detecting diffuse myocardial disease by T1 mapping can discriminate between HCM versus hypertensive heart disease as well as to detect genetically driven interstitial changes in the G+P− subjects. (HCM, n=95; hypertension, n=69) and G+P− subjects (n=23) underwent a clinical cardiovascular magnetic resonance protocol (3 tesla) for cardiac volumes, function, and scar imaging. T1 mapping was performed before and >20 minutes after administration of 0.2 mmol/kg of gadobutrol. Native T1 and extracellular volume fraction were significantly higher in HCM compared with patients with hypertension (P<0.0001), including in subgroup comparisons of HCM subjects without evidence of late gadolinium enhancement, as well as of hypertensive patients LV wall thickness of >15 mm (P<0.0001). Compared with controls, native T1 was significantly higher in G+P− subjects (P<0.0001) and 65% of G+P− subjects had a native T1 value >2 SD above the mean of the normal range. Native T1 was an independent discriminator between HCM and hypertension, over and above extracellular volume fraction, LV wall thickness and indexed LV mass. Native T1 was also useful in separating G+P− subjects from controls. Conclusions-Native T1 may be applied to discriminate between HCM and hypertensive heart disease and detect early changes in G+P− subjects. (Figure 1). Methods and Results-Patients with diagnoses of HCM or hypertension 8-12Although T1 mapping supports detection of diffuse myocardial disease, late gadolinium enhancement (LGE) helps with visualizing regional changes, such as replacement fibrosis in phenotypically subexpressed HCM gene carriers (G+P− subjects) and overt HCM disease. In compensated LVH because of hypertension-that is before extensive structural and metabolic remodeling with cavity dilatation and functional impairment (eccentric remodeling)-findings reflect physiological adaptations with an increased cellular size because of addition of new, but functional myofibrilles in-parallel and in-series, enabling the ventricle to generate greater forces and to outweigh the increased wall stress. 11,[13][14][15][16][17] Interstitial fibrosis and the expansion of extracellular space in hypertension herald decompensation with eccentric remodeling and heart failure. [12][13][14][15][18][19][20][21][22] In this study, we investigated the ability of CMR to discern hypertrophic phenotypes based on detection of diffuse myocardial disease and regional fibrosis by myocardial T1 mapping and LGE, respectively, first, in overt LVH, and second, in phenotypically subexpressed HCM gene carriers. MethodsConsecutive subjects en...

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Histological validation of cardiac magnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis

Abstract: CMR provides accurate, non-invasive assessment of regional myocardial fibrosis using LGE, while diffuse interstitial myocardial fibrosis is accurately assessed with post-contrast T1 mapping.

Cited by 216 publications

References 24 publications

T1 Mapping in Characterizing Myocardial Disease

T1 Mapping in Characterizing Myocardial Disease

Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction

T1 Mapping in Discrimination of Hypertrophic Phenotypes: Hypertensive Heart Disease and Hypertrophic Cardiomyopathy

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