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
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Figure 1 Calculating Myocardial T1 Time
A region of interest (ROI) was drawn around the left ventricular myocardium in the 10 images obtained from our prototype sequence (A). Signal intensities for each ROI were then curve-fitted to an exponential recovery curve to obtain the myocardial T1 time for each patient (B). Conventional delayed enhancement imaging (C) was used to demonstrate regional fibrosis.
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Figure 2 Histologic Findings
Endomyocardial tissue from 2 patients showing minimal (A) and more extensive (B) interstitial fibrosis. Sections were stained with picrosirius red with collagen identified in red and myocytes appearing yellow.
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Figure 3 Myocardial Collagen Content and Post-Contrast T1 Times
Endomyocardial biopsy specimens from 9 subjects after cardiac transplantation were stained with picrosirius red, and collagen content was calculated as a percentage of total myocardial tissue. The post-contrast myocardial T1 time shortened significantly as the myocardial collagen content increased (r = –0.7, p = 0.03).
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Figure 4 Post-Contrast Myocardial T1 Times
The myocardium of subjects with heart failure (congestive cardiac failure [CCF]) and regional fibrosis detected by conventional delayed contrast-enhanced imaging was divided into areas with (DE+) and without (DE–) regional scarring. The post-contrast myocardial T1 time was significantly shorter in DE– regions compared with controls, consistent with diffuse fibrosis even in areas of myocardium not displaying regional scarring (*p < 0.0001). There was also a difference in the post-contrast myocardial T1 time of heart failure subjects between DE– and DE+ areas of myocardium (p = 0.02).
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Figure 5 Diastolic Function and Myocardial T1 Times
Post-contrast myocardial T1 time progressively shortened with worsening grades of diastolic function (*p < 0.001, analysis of variance).
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