Native T1 reference values for nonischemic cardiomyopathies and populations with increased cardiovascular risk: A
Maaike van den Boomen1, Riemer H J A Slart2, Enzo V Hulleman3
1Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard-MIT Health Science and Technology, USA.
Insights
This study determined native myocardial T1 value ranges in nonischemic cardiomyopathies and at-risk populations. Cardiac T1 mapping shows potential for assessing myocardial changes in various heart conditions.
Area of Science:
- Cardiovascular imaging
- Medical physics
- Biomedical engineering
Background:
- Cardiac magnetic resonance (MR) and T1 mapping are increasingly vital for diagnosing diffuse fibrosis-based cardiac diseases.
- Existing studies on T1 values in healthy and diseased myocardium, especially in nonischemic cardiomyopathies (NICM) and high-cardiovascular-risk populations, present conflicting findings.
Purpose of the Study:
- To establish the native myocardial T1 value ranges in patients diagnosed with NICM.
- To determine the native myocardial T1 value ranges in populations with elevated cardiovascular risk.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- PubMed and Embase databases were searched for relevant studies.
- Random-effects model and meta-regression analysis were employed to calculate the summary of standard mean difference (SMD) between diseased and healthy populations.
Main Results:
- Significantly increased SMDs for T1 values were observed in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and myocarditis (MC) patients compared to controls.
- Hypertension (HT) patients with left-ventricle hypertrophy (LVH) showed a significant increase in SMD, while those without LVH did not.
- Limited data for amyloidosis, iron overload, Fabry disease, and HT with LVH precluded meta-analysis, but trends indicated increased T1 in amyloidosis/HT with LVH and decreased T1 in iron overload/Fabry disease.
Conclusions:
- Native T1 mapping using (Sh)MOLLI sequences can potentially assess myocardial alterations in conditions like HCM, DCM, MC, amyloidosis, iron overload, and Fabry disease.
- T1 mapping may also aid in diagnosing left-ventricular remodeling in HT patients.
- Further research is needed for conditions with limited study data.
Background:
Although cardiac MR and T1 mapping are increasingly used to diagnose diffuse fibrosis based cardiac diseases, studies reporting T1 values in healthy and diseased myocardium, particular in nonischemic cardiomyopathies (NICM) and populations with increased cardiovascular risk, seem contradictory.
Purpose:
To determine the range of native myocardial T1 value ranges in patients with NICM and populations with increased cardiovascular risk.
Study Type:
Systemic review and meta-analysis.
Population:
Patients with NICM, including hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), and patients with myocarditis (MC), iron overload, amyloidosis, Fabry disease, and populations with hypertension (HT), diabetes mellitus (DM), and obesity. FIELD STRENGTH/SEQUENCE: (Shortened) modified Look-Locker inversion-recovery MR sequence at 1.5 or 3T.
Assessment:
PubMed and Embase were searched following the PRISMA guidelines.
Statistical Tests:
The summary of standard mean difference (SMD) between the diseased and a healthy control populations was generated using a random-effects model in combination with meta-regression analysis.
Results:
The SMD for HCM, DCM, and MC patients were significantly increased (1.41, 1.48, and 1.96, respectively, P < 0.01) compared with healthy controls. The SMD for HT patients with and without left-ventricle hypertrophy (LVH) together was significantly increased (0.19, P = 0.04), while for HT patients without LVH the SMD was zero (0.03, P = 0.52). The number of studies on amyloidosis, iron overload, Fabry disease, and HT patients with LVH did not meet the requirement to perform a meta-analysis. However, most studies reported a significantly increased T1 for amyloidosis and HT patients with LVH and a significant decreased T1 for iron overload and Fabry disease patients.
Data Conclusions:
Native T1 mapping by using an (Sh)MOLLI sequence can potentially assess myocardial changes in HCM, DCM, MC, iron overload, amyloidosis, and Fabry disease compared to controls. In addition, it can help to diagnose left-ventricular remodeling in HT patients.
Level Of Evidence:
2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:891-912.
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