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Non-invasive Evaluation of Myocardial Fibrosis Using T1 and T2 Mapping by Cardiac Magnetic Resonance Imaging
Maynor Jose Lopez Mendoza1, Nicolle Contreras Figueroa2, Maria Antonieta Salazar Estrada3
1Anesthesiology and Perioperative Medicine, Hospital de las Mujeres Dr. Adolfo Carit Eva (CARITEVA), San José, CRI.
Insights
Myocardial fibrosis, a key factor in heart disease outcomes, can be accurately assessed using cardiac magnetic resonance (CMR) parametric mapping. These advanced CMR techniques offer precise quantification of fibrosis and inflammation, improving risk stratification and treatment guidance.
Area of Science:
- Cardiology
- Medical Imaging
- Pathology
Background:
- Myocardial fibrosis is a significant contributor to adverse outcomes in various cardiovascular diseases, including heart failure, arrhythmias, and sudden cardiac death.
- Fibrosis can manifest as focal or diffuse interstitial patterns, driven by fibroblast activation and sustained extracellular matrix deposition, often amplified by inflammation and edema.
- Cardiac magnetic resonance (CMR) imaging is a crucial non-invasive tool for assessing myocardial tissue characteristics.
Purpose of the Study:
- To evaluate the role of advanced CMR parametric mapping techniques in characterizing myocardial fibrosis and inflammation.
- To highlight the clinical utility of T1, T2, and extracellular volume fraction mapping in cardiovascular disease management.
Main Methods:
- Utilized advanced cardiac magnetic resonance (CMR) parametric mapping techniques, including native T1 mapping, T2 mapping, and extracellular volume (ECV) fraction mapping.
- Assessed the ability of these quantitative mapping techniques to detect and quantify diffuse interstitial myocardial fibrosis and myocardial edema/inflammation.
- Compared the diagnostic and prognostic performance of parametric mapping with conventional imaging modalities and biomarkers.
Main Results:
- Native T1 mapping and ECV fraction mapping effectively detect and quantify diffuse myocardial fibrosis, demonstrating significant prognostic value.
- T2 mapping is highly sensitive to myocardial edema and active inflammation, aiding in the differentiation of acute versus chronic myocardial injury.
- Integrated parametric mapping provides a comprehensive assessment of the inflammation-fibrosis continuum, offering superior tissue specificity and quantitative characterization compared to other methods.
Conclusions:
- CMR parametric mapping techniques (T1, T2, ECV) offer a robust, quantitative, and reproducible method for assessing myocardial fibrosis and inflammation.
- These advanced imaging techniques enhance risk stratification, predict adverse remodeling, guide therapeutic decisions, and monitor treatment response in diverse cardiovascular conditions.
- Parametric mapping represents a significant advancement in myocardial tissue characterization, providing deeper insights into the pathophysiology of cardiovascular diseases.
Abstract:
Myocardial fibrosis is a common pathological substrate across a broad spectrum of cardiovascular diseases and represents a key determinant of adverse clinical outcomes, including heart failure progression, arrhythmias, and sudden cardiac death. It may present as focal replacement fibrosis, typically following myocardial infarction, or as diffuse interstitial fibrosis, more frequently observed in non-ischemic cardiomyopathies and pressure-overload conditions. At the cellular level, fibrosis is driven by fibroblast activation and differentiation into myofibroblasts, mediated by profibrotic signaling pathways and sustained extracellular matrix deposition. Inflammation and myocardial edema also play a critical role in initiating and amplifying fibrotic remodeling, linking acute injury to chronic structural changes. Cardiac magnetic resonance imaging has emerged as a reference non-invasive modality for myocardial tissue characterization. Parametric mapping techniques, including T1, T2, and extracellular volume fraction mapping, provide a quantitative and highly reproducible assessment of myocardial composition. Native T1 mapping and extracellular volume fraction allow sensitive detection and quantification of diffuse myocardial fibrosis and have demonstrated significant prognostic value across several cardiovascular conditions, while T2 mapping is particularly sensitive to myocardial edema and active inflammation, enabling differentiation between acute and chronic myocardial injury. When integrated, these techniques enable a comprehensive evaluation of the inflammation-fibrosis continuum. Clinically, T1 and T2 mapping have demonstrated substantial value across ischemic and non-ischemic heart diseases, valvular disorders, and infiltrative cardiomyopathies. These techniques contribute to improved risk stratification, prediction of adverse ventricular remodeling, guidance of therapeutic decision-making, and monitoring of treatment response. Compared with late gadolinium enhancement imaging, echocardiographic strain analysis, and circulating biomarkers, parametric mapping offers greater tissue specificity and quantitative characterization of myocardial remodeling, although its implementation requires specialized equipment and technical expertise.
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