Author + information
- Received November 13, 2019
- Revision received May 12, 2020
- Accepted May 15, 2020
- Published online October 5, 2020.
- Taku Omori, MDa,
- Shiro Nakamori, MDa,∗ (, )
- Naoki Fujimoto, MDa,
- Masaki Ishida, MDb,
- Kakuya Kitagawa, MDb,
- Yasutaka Ichikawa, MDb,
- Naoto Kumagai, MDa,
- Tairo Kurita, MDa,
- Kyoko Imanaka-Yoshida, MDc,
- Michiaki Hiroe, MDc,
- Hajime Sakuma, MDb,
- Masaaki Ito, MDa and
- Kaoru Dohi, MDa
- aDepartment of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
- bDepartment of Radiology, Mie University Graduate School of Medicine, Mie, Japan
- cResearch Center for Matrix Biology, Mie University, Mie, Japan
- ↵∗Address for correspondence:
Dr. Shiro Nakamori, Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
Objectives This study sought to evaluate the potential of cardiac magnetic resonance T1 mapping to detect load-independent left ventricular (LV) chamber stiffness by histological confirmation.
Background Accurate noninvasive diagnosis of LV diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) remains challenging.
Methods Nineteen HFpEF patients (14 female, 65 ± 16 years of age) without primary cardiomyopathy were prospectively enrolled. Cine, late gadolinium enhancement cardiac magnetic resonance, and triple-slice T1 mapping using a modified Look-Locker inversion recovery sequence were performed at 3-T. Extracellular volume (ECV) was quantified from pre- and post-contrast T1 values of the blood and myocardium with hematocrit correction. LV stiffness constant (beta) was assessed by calculating the slope of the end-diastolic pressure–volume relationship curve during vena cava occlusion. Biopsy samples were used for quantification of collagen volume fraction (CVF) and myocardial cell size.
Results Six patients showed focal scar on late gadolinium enhancement. There was no significant difference in histological CVF between patients with and without focal myocardial scarring (p = 0.2). Septal ECV rather than native T1 was a better surrogate marker for detecting histological CVF (r = 0.54; p = 0.02, and r = 0.44; p = 0.06, respectively). Global native T1 and ECV, but not native T1 and ECV in the septal myocardium, correlated well with the beta of passive LV stiffness, and had similar ability for predicting LV stiffness to histological CVF (r = 0.54, 0.50, 0.53, all p < 0.05, respectively). When the beta ≥0.054 was considered as moderately increased LV stiffness, global native T1 ≥1,362 ms provided 88% sensitivity and 64% specificity with the C-statistic of 0.81 (95% confidence interval: 0.56 to 0.95).
Conclusions Myocardial native T1 provides comparable ability in predicting LV stiffness to ECV and histological CVF and may be useful for monitoring patients with HFpEF who have renal dysfunction, allergy to gadolinium, or wheezing that can simulate asthma. Our feasibility study shows the potential of native T1 to allow for insight of heterogeneous pathophysiology and better risk stratification of HFpEF.
- cardiovascular magnetic resonance
- heart failure with preserved ejection fraction
- histological collagen volume fraction
- left ventricular stiffness
- native T1
Dr. Sakuma has received departmental research grant support from Daiichi-Sankyo, FUJIFILM Holdings, Nihon Medi-Physics, Bayer, Siemens, Fuji Pharma, Guerbet, and Eisai. Dr. Ito has received departmental research grant support from Bristol-Myers Squibb, Merck Sharp and Dohme (MSD) K.K., Shionogi and Co., Otsuka Pharmaceutical, Takeda Pharmaceutical, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received November 13, 2019.
- Revision received May 12, 2020.
- Accepted May 15, 2020.
- 2020 American College of Cardiology Foundation
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