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. 2020 May 24;10(5):335.
doi: 10.3390/diagnostics10050335.

The Doubled-Edged Sword of T1-Mapping in Systemic Sclerosis-A Comparison with Infectious Myocarditis Using Cardiovascular Magnetic Resonance

George Markousis-Mavrogenis  1 , Loukia Koutsogeorgopoulou  2 , Gikas Katsifis  3 , Theodoros Dimitroulas  4 , Genovefa Kolovou  1 , George D Kitas  5 , Petros P Sfikakis  6 , Sophie I Mavrogeni  1   7
Affiliations

The Doubled-Edged Sword of T1-Mapping in Systemic Sclerosis-A Comparison with Infectious Myocarditis Using Cardiovascular Magnetic Resonance

George Markousis-Mavrogenis et al. Diagnostics (Basel). .

Abstract

Aims: T1-mapping is considered a surrogate marker of acute myocardial inflammation. However, in diffuse cutaneous systemic sclerosis (dcSSc) this might be confounded by coexisting myocardial fibrosis. We hypothesized that T1-based indices should not by themselves be considered as indicators of myocardial inflammation in dcSSc patients.

Methods/results: A cohort of 59 dcSSc and 34 infectious myocarditis patients was prospectively evaluated using a 1.5-Tesla system for an indication of suspected myocardial inflammation and was compared with 31 healthy controls. Collectively, 33 (97%) and 57 (98%) of myocarditis and dcSSc patients respectively had ≥1 pathologic T2-based index. However, 33 (97%) and 45 (76%) of myocarditis and dcSSc patients respectively had ≥1 pathologic T2-based index. T2-signal ratio was significantly higher in myocarditis patients compared with dcSSc patients (2.5 (0.6) vs. 2.1 (0.4), p < 0.001). Early gadolinium enhancement, late gadolinium enhancement and T2-mapping did not differ significantly between groups. However, both native T1-mapping and extracellular volume fraction were significantly lower in myocarditis compared with dcSSc patients (1051.0 (1027.0, 1099.0) vs. 1120.0 (1065.0, 1170.0), p < 0.001 and 28.0 (26.0, 30.0) vs. 31.5 (30.0, 33.0), p < 0.001, respectively). The original Lake Louise criteria (LLc) were positive in 34 (100%) myocarditis and 40 (69%) dcSSc patients, while the updated LLc were positive in 32 (94%) and 44 (76%) patients, respectively. Both criteria had good agreement with greater but nonsignificant discordance in dcSSc patients.

Conclusions: ~25% of dcSSc patients with suspected myocardial inflammation had no CMR evidence of acute inflammatory processes. T1-based indices should not be used by themselves as surrogates of acute myocardial inflammation in dcSSc patients.

Keywords: ECV; Lake Louise criteria; T2-mapping; cardiovascular magnetic resonance; myocardial edema; myocardial fibrosis; parametric; scleroderma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) A three-dimensional scatterplot of native T1-mapping (ms), T2-mapping (ms) and extracellular volume fraction (ECV) (%) values, colored by patient group. For each pairwise combination the corresponding point is projected on a side of the graph. (B) The same three-dimensional scatterplot with the addition of a horizontal plane at the pathologic cut-off value for ECV measurements used in this study (>29%). An interactive version of this plot is included as Supplementary Materials. ms milliseconds
Figure 2
Figure 2
Two-dimensional scatterplots and boxplots for native T1-mapping, T2-mapping and ECV with individuals color coded according to the study group they belonged to. Spearman’s correlation coefficients are presented for each combination of the three indices collectively and for each group separately. The distribution of each variable per group is also presented as a density plot. ECV: extracellular volume fraction.
See this image and copyright information in PMC

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