Characterization of Compacted Myocardial Abnormalities by Cardiac Magnetic Resonance with Native T1 Mapping in Left Ventricular Non-compaction Patients: A Comparison with Late Gadolinium Enhancement
Hongmei Zhou1, Xue Lin1, Haiyan Ding2, and Quan Fang1

1Cardiology, Peking Union Medical College, Beijing, China, People's Republic of, 2Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China, People's Republic of

Synopsis

Left Ventricular Non-compaction (LVNC) manifesting with myocardial fibrosis can cause cardiac dysfunction, arrhythmia, and sudden death. Native T1 mapping is an emerging CMR technique in quantitative evaluation of myocardial fibrosis. This study aimes to investigate the usefulness of native T1 mapping in characterization of myocardial abnormalities in LVNC patients by comparing with late gadolinium enhancement. It may suggest that native T1 mapping may provide information for early detection of fibrosis in compacted myocardium and stratification of severity in Left Ventricular Non-compaction.

Aims

The aim of this study was to investigate the usefulness of native T1 mapping in characterization of myocardial abnormalities in Left Ventricular Non-compaction (LVNC) patients as compared with Late Gadolinium Enhancement (LGE).

Background

LVNC manifesting with myocardial fibrosis can cause cardiac dysfunction, arrhythmia, and sudden death in patients. However, identifying the high risk patients from the wide clinical spectrum of LVNC patients is difficult. Native T1 mapping is an emerging cardiac magnetic resonance technique in quantitative evaluation of myocardial fibrosis. This study aimed to investigate the usefulness of native T1 mapping in characterization of myocardial abnormalities in LVNC patients by comparing with LGE.

Methods

Thirty-one LVNC patients(19 males and 12 females; mean age, 42 ± 12 years), and 14 normal controls(9 male and 5 female; mean age, 45 ± 15 years) underwent CMR(3.0T, Achieva TX, Philips Healthcare, Best, Netherlands) with modified look-locker inversion recovery sequence (MOLLI) to acquire native T1 maps. Furthermore, all the patients were scanned with an inversion-recovery sequence, after injecting 0.2 mmol/kg of gadolinium-DTPA 5 ± 5 min to obtain LGE images. Patients were divided into two groups: patients with LGE (LGE+) and patients without LGE (LGE-). All CMR data were analyzed using MATLAB (MathWorks, Natick, Massachusetts, USA). One Way ANOVA and Univariate Logistic Regression were used for statistical analysis. A p value of p <0.05 was considered as statistically significant.

Results

As it was shown in Figs. 1 and 2. Of 31 LVNC patients, 14 (45%) had LGE. LVNC patients with LGE showed significantly higher native T1 values than those without LGE (1181.4±53.7 ms vs. 1140.6±32.8 ms, p=0.014). The native T1 of LVNC patients without LGE was significantly higher than normal controls (1140.6±32.8 ms vs. 1,098.8±40.8 ms, p=0.011). In discriminating presence of LGE in LVNC patients, the odds ratio and coresponding 95% confidence interval (CI) of native T1 was respectively 2.966 (95% CI: 1.123-7.835, p=0.028) and 4.330 (95% CI: 1.175-15.957, p=0.028) before and after adjusting for age, gender, and body surface area with the increment of 1 standard deviation (SD) of the native T1 value.

Conclusions

Myocardial native T1 is significantly associated with LGE in LVNC patients, indicating its potential in stratification of disease severity. The findings of LVNC patients without LGE having elevated native T1 compared with normal controls suggests that the native T1 mapping might be a useful tool for early detection of myocardial fibrosis.

Acknowledgements

This study was supported by Key Projects in the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.2011BAI11B11).

References

1. Petersen SE, Selvanayagam JB, Wiesmann F, Robson MD, Francis JM, Anderson RH, Watkins H, Neubauer S. Left ventricular non-compaction: Insights from cardiovascular magnetic resonance imaging. Journal of the American College of Cardiology. 2005;46:101-105

2. Chaowu Y, Li L, Shihua Z. Histopathological features of delayed enhancement cardiovascular magnetic resonance in isolated left ventricular noncompaction. Journal of the American College of Cardiology. 2011;58:311-312

3. Towbin JA, Lorts A, Jefferies JL. Left ventricular non-compaction cardiomyopathy. Lancet. 2015

4. Wan J, Zhao S, Cheng H, Lu M, Jiang S, Yin G, Gao X, Yang Y. Varied distributions of late gadolinium enhancement found among patients meeting cardiovascular magnetic resonance criteria for isolated left ventricular non-compaction. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 2013;15:20

5. Bull S, White SK, Piechnik SK, Flett AS, Ferreira VM, Loudon M, Francis JM, Karamitsos TD, Prendergast BD, Robson MD, Neubauer S, Moon JC, Myerson SG. Human non-contrast t1 values and correlation with histology in diffuse fibrosis. Heart. 2013;99:932-937

6. Jellis CL, Kwon DH. Myocardial t1 mapping: Modalities and clinical applications. Cardiovascular diagnosis and therapy. 2014;4:126-137

Figures

Fig. 1 CMR end-diastolic frame from cine (the left two panels, long axis), modified look-locker inversion recovery (MOLLI) native T1 map (right panel), and LGE images (the third panel) in normal control (case 1), LGE- patient (case 2) and LGE+ patient (case 3). The k with extensive LGE (yellow arrows), while c and j without LGE. Note the markedly elevated myocardial T1 time in the LGE+ patient (1,234 ms), followed by LGE- patient (1142 ms) and normal control (1033 ms).

Fig. 2 Mean native T1 values in 3 groups of subjects (normal control, LGE- patients and LGE+ patients). Error bars indicate ±1 SD. Significant differences between any two groups by One Way ANOVA.



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
3158