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CLINICAL RESEARCH: CARDIAC IMAGING

Evaluation of Diffuse Myocardial Fibrosis in Heart Failure With Cardiac Magnetic Resonance Contrast-Enhanced T₁ Mapping

Leah Iles, MBChB^_*, Heinz Pfluger, MD^_*, Arintaya Phrommintikul, MD^_*, Joshi Cherayath, Dip AMIT, Pelin Aksit, MS, Sandeep N. Gupta, PhD, David M. Kaye, PhD^_* and Andrew J. Taylor, PhD^_*,_*

^_* Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Australia
GE Healthcare, Melbourne, Australia
Global Applied Science Laboratory, GE Healthcare, Bethesda, Maryland

Manuscript received February 13, 2008; revised manuscript received May 8, 2008, accepted June 10, 2008.

^_* Reprint requests and correspondence: Dr. Andrew J. Taylor, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Heart Centre, Alfred Hospital, Commercial Road, Melbourne 3004, Australia (Email: andrew.taylor{at}bakeridi.edu.au).

Objectives: The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI).

Background: Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis.

Methods: We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T₁ mapping sequence was used to calculate the post-contrast myocardial T₁ time as an index of diffuse fibrosis; regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation.

Results: Post-contrast myocardial T₁ times correlated histologically with fibrosis (R = –0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 ± 17 ms vs. 564 ± 23 ms, p < 0.0001). The T₁ time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 ± 22 ms vs. 564 ± 23 ms, p < 0.0001). The post-contrast myocardial T₁ time shortened as diastolic function worsened (562 ± 24 ms in normal diastolic function vs. 423 ± 33 ms in impaired diastolic function vs. 368 ± 20 ms in restrictive function, p < 0.001).

Conclusions: Contrast-enhanced CMRI T₁ mapping identifies changes in myocardial T₁ times in heart failure, which appear to reflect diffuse fibrosis.

Key Words: cardiac magnetic resonance imaging • fibrosis • heart failure • cardiomyopathy

Abbreviations and Acronyms   CCF = congestive cardiac failure   CMRI = cardiac magnetic resonance imaging   DE– = myocardium without delayed enhancement   DE+ = myocardium with delayed enhancement   ECG = electrocardiogram   GFR = glomerular filtration rate   ICMP = ischemic cardiomyopathy   IDCM = idiopathic dilated cardiomyopathy   LVEF = left ventricular ejection fraction   ROI = region of interest   TTE = transthoracic echocardiography

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