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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
T1 mapping and speckle tracking echocardiography for the assessment of early mechanical dysfunction in
Federico Marchini1, Michele Malagù1, Federica Frascaro1
1Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.
Insights
In transfusion-dependent β-thalassemia (TDT) patients with normal iron overload (T2* > 20 ms), T1 mapping showed a weak correlation with cardiac mechanics. Early cardiac dysfunction was not more prevalent in those with reduced T1 values.
Area of Science:
- Cardiology
- Radiology
- Hematology
Background:
- Cardiovascular magnetic resonance (CMR) T2* sequences (≤ 20 ms) indicate iron overload cardiomyopathy in transfusion-dependent β-thalassemia (TDT).
- The role of T1 mapping in detecting early myocardial dysfunction in TDT patients with normal T2* values remains under-investigated.
Purpose of the Study:
- To assess the utility of T1 mapping in identifying early cardiac mechanical dysfunction.
- To correlate T1 mapping with echocardiographic indices in TDT patients with normal T2*.
Main Methods:
- 154 TDT patients with T2* > 20 ms were analyzed.
- Patients were stratified based on T1 mapping values (≤ 955 ms vs. > 955 ms).
- Cardiovascular magnetic resonance (CMR) T1 mapping and speckle tracking echocardiography (STE) were performed, correlating T1 values with STE indices like global longitudinal strain (GLS).
Main Results:
- T1 mapping showed statistically significant, albeit weak, correlations with GLS (r = -0.19, p = 0.01), global work index (GWI, r = 0.15, p = 0.04), global constructive work (GCW, r = 0.18, p = 0.02), and peak atrial longitudinal strain (PALS, r = 0.2, p < 0.01).
- The prevalence of cardiac mechanical dysfunction was low overall.
- No significant difference in cardiac mechanical dysfunction was observed between TDT patients with reduced T1 mapping and those with normal T1 mapping.
Conclusions:
- In TDT patients with normal T2* values, T1 mapping has a limited but significant correlation with echocardiographic measures of cardiac mechanics.
- T1 mapping did not identify a higher prevalence of cardiac mechanical dysfunction in TDT patients with normal T2* values.
Background:
A T2* ≤20 ms in cardiovascular magnetic resonance (CMR) sequences suggests the presence of iron overload cardiomyopathy in patients with transfusion-dependent β-thalassemia (TDT). However, there is still a gap in evidence regarding the independent role of T1 mapping in identifying early myocardial dysfunction. The aim of this study is to investigate the role of T1 mapping in identifying early cardiac mechanical dysfunction in TDT patients with normal T2* values.
Methods:
About 154 consecutive TDT patients with T2* >20 ms were enrolled and stratified by reduced (≤955 ms) or normal (>955 ms) T1 mapping values. CMR T1 mapping and speckle tracking echocardiography (STE) indices were evaluated. The primary endpoint was the correlation between T1 mapping and STE indices. The secondary endpoint was the prevalence of cardiac mechanical dysfunction between patients with reduced or normal T1 mapping.
Result:
T1 mapping showed statistically significant correlations with global longitudinal strain (GLS, r = -0.19, p = 0.01), global work index (GWI, r = 0.15, p = 0.04), global constructive work (GCW, r = 0.18, p = 0.02), and peak atrial longitudinal strain (PALS, r = 0.2, p<0.01). The prevalence of cardiac mechanical dysfunction was low, without any difference between patients with reduced or normal T1 mapping.
Conclusions:
In TDT patients with normal T2*, T1 mapping demonstrated a weak but significant correlation with echocardiographic indices of cardiac mechanics. The prevalence of cardiac mechanical dysfunction was low without any difference between those with reduced or normal T1 mapping.
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