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. 2014 Apr 25;16(1):28.
doi: 10.1186/1532-429X-16-28.

In-vivo T1 cardiovascular magnetic resonance study of diffuse myocardial fibrosis in hypertrophic cardiomyopathy

Wessel P Brouwer  1 , Emma N Baars, Tjeerd Germans, Karin de Boer, Aernout M Beek, Jolanda van der Velden, Albert C van Rossum, Mark B M Hofman
Affiliations

In-vivo T1 cardiovascular magnetic resonance study of diffuse myocardial fibrosis in hypertrophic cardiomyopathy

Wessel P Brouwer et al. J Cardiovasc Magn Reson. .

Abstract

Background: In hypertrophic cardiomyopathy (HCM), autopsy studies revealed both increased focal and diffuse deposition of collagen fibers. Late gadolinium enhancement imaging (LGE) detects focal fibrosis, but is unable to depict interstitial fibrosis. We hypothesized that with T1 mapping, which is employed to determine the myocardial extracellular volume fraction (ECV), can detect diffuse interstitial fibrosis in HCM patients.

Methods: T1 mapping with a modified Look-Locker Inversion Recovery (MOLLI) pulse sequence was used to calculate ECV in manifest HCM (n = 16) patients and in healthy controls (n = 14). ECV was determined in areas where focal fibrosis was excluded with LGE.

Results: The total group of HCM patients showed no significant changes in mean ECV values with respect to controls (0.26 ± 0.03 vs 0.26 ± 0.02, p = 0.83). Besides, ECV in LGE positive HCM patients was comparable with LGE negative HCM patients (0.27 ± 0.03 vs 0.25 ± 0.03, p = 0.12).

Conclusions: This study showed that HCM patients have a similar ECV (e.g. interstitial fibrosis) in myocardium without LGE as healthy controls. Therefore, the additional clinical value of T1 mapping in HCM seems limited, but future larger studies are needed to establish the clinical and prognostic potential of this new technique within HCM.

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Figures

Figure 1
Figure 1
The selection of myocardial regions with different signal intensities in a LGE-positive HCM patient. Image A represents a short axis LGE image of a HCM patient, showing extensive focal fibrosis in the myocardium (white areas). The maximum signal (max SI) was determined by drawing a small ROI in the core of the region with focal fibrosis. Image B, which is the identical CMR image as (A) but with a segmentation overlay, shows non-enhanced myocardium (SI <20% max SI), intermediate enhanced myocardium in yellow (>20 and <50% of max SI) and enhanced myocardium in red (SI >50% of max SI) using the thresholding algorithm. Image C, D, and E show manually drawn ROI’s on corresponding T1 maps for non-enhanced, intermediate enhanced, and enhanced myocardium, respectively. LGE = late gadolinium enhancement. SI = signal intensity. ROI = region of interest.
Figure 2
Figure 2
ECV values in regions with different myocardial enhancement at LGE-images in HCM patients with focal fibrosis. Regions in the core of focal fibrosis (SI >50%), apparent normal regions (SI <20%), and regions with intermediate enhancement (SI 20-50%) *p < 0.05, † p < 0.01, § p < 0.001. ECV = Extracellular volume fraction. SI = signal intensity.
Figure 3
Figure 3
Extracellular volume fraction (ECV) values in non-enhanced myocardium in HCM patients and controls. The group of HCM patients is subdivided into patients with focal fibrosis on LGE (HCM-LGE+) and without focal fibrosis (HCM-LGE-). Notice that solely the group of ‘hypertensive HCM’ patients shows a significantly higher ECV compared to the other groups. ECV = extracellular volume fraction. HCM = hypertrophic cardiomyopathy. LGE = late gadolinium enhancement. * p < 0.05.
See this image and copyright information in PMC

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