Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Contrast-agent free evaluation of cardiomyopathies with T1 mapping and the new fast strain-encoded (fSENC) magnetic resonance imaging
O. Paul1, J. Salatzki1, S. Braun2, F. André1, J. Riffel1, M. Ochs3, M. Friedrich1, N. Frey1, H. A. Katus1, K. Hirschberg2
1Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; 2Heart and Vascular Center, Semmelweis University, Budapest, HU; 3Innere Medizin II - Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus Mannheim und St. Hedwig Klinik GmbH, Mannheim;

Background: Cardiomyopathies (CMP) may cause impairment of cardiac function and structure. Cardiac Magnetic Resonance Imaging (CMR) is used for analysis and risk stratification of CMP by Late Gadolinium Enhancement (LGE). However, T1 mapping (T1) and fast strain encoded (f-SENC) sequences allow contrast-free and faster exams. The aim of this study was to characterize CMP by T1 and f-SENC to develop a faster and safer CMR protocol (fast-CMR).

Methods: CMP scans from our CMR database were retrospectively analyzed. All patients were scanned at 1.5T/3T scanner. Study groups were divided as follows: Subjects with normal findings, patients with dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and cardiac amyloidosis. Global T1 times, longitudinal (GLS) and circumferential (GCS) strain using f-SENC of study groups were compared to healthy individuals (controls). Scan time and amount of gadolinium-based contrast agent (CA) in CMR-protocol with LGE were compared to fast-CMR.

Results: 205 patients and 68 controls were recruited. T1 times in 3T and GLS were not significantly different between controls and subjects with normal findings, a slight but significant difference (p<0.05) in GCS and T1 time (1.5T) was found between these groups. T1 times were significantly increased (p<0.05), while GLS and GCS were significantly reduced (p<0.05) in all CMP-groups compared to controls except for T1 times (3T) in HHD (Table 1). Using fast-CMR 21(±6)min of scan time were saved, about 47%, and 9(±2)ml of CA were saved per patient.

Conclusion: Normal findings could be identified by fast-CMR without contrast agent. Fast CMR might also be a useful tool to identify different forms of CMP.

Table 1

Study groups

Control

Normal finding

DCM

HCM

HHD

Cardiac amyloidosis

Group Parameters

 

 

 

 

 

 

n

68

80

44

47

26

8

Age

50±17

39±15*

53±15

48±17

59*

70±9*

Male (%)

38 (55)

40 (50)

24 (55)

31 (66)

18 (69)

6 (71)

 

LVEF (%)

64±5

61±4*

39±11*

65±7

61±8

48±15*

 

EDV (ml)

146±31

162±41*

236±63*

160±34*

156±39

169±41

 

LV Mass (g)

91±22

98±25

132±33*

165±58*

126±39*

181±93*

CMR Parameters

 

 

 

 

 

Global T1 in 1.5T (ms)

994±18

1,005±23*

1,044±31*

1,032±29*

1,017±30*

1,154±48*

Global T1 in 3T (ms)

1,223±23

1,229±22

1,289±46*

1,305±50*

1,241±32

N.A.

No. of elevated T1-Seg.a

2±2

2±2*

8±4*

8±5*

4±4*

16±1*

GCS (%)

-21.1±1.2

-20.5±1.4*

-13.2±4.1*

-14.8±2.8*

-16.5±3.1*

-12.2±4.7*

GLS (%)

-20.3±1.6

-20.2±1.5

-13.1±3.6*

-12.9±4.4*

-16.8±3.1*

-8.6±5.1*

No. of reduced Strain-Seg.b

5±3

7±3*

24±7*

22±6*

17±6*

28±7*

 

DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; HHD, hypertensive heart disease; LVEF, left ventricular ejection fraction; EDV, end-diastolic volume; LV Mass, left ventricular mass; GCS, global circumferential strain; GLS, global longitudinal strain

aElevated T1-Segments (T1-Seg.) are defined as >1031ms in 1.5T and >1267ms in 3T in 17-segment model (AHA)

bReduced Strain-Segments (Strain-Seg.) are defined as >-17% in GLS plus GCS segments

*significant (p<0.05) differences between control and study group

 

https://dgk.org/kongress_programme/jt2021/aP1501.html