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Journal of Cardiovascular Magnetic Resonance

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01-12-2020 | Aortic Valve Replacement | Research

Real-time cardiovascular magnetic resonance T1 and extracellular volume fraction mapping for tissue characterisation in aortic stenosis

Authors: Sören J. Backhaus, Torben Lange, Bo Eric Beuthner, Rodi Topci, Xiaoqing Wang, Johannes T. Kowallick, Joachim Lotz, Tim Seidler, Karl Toischer, Elisabeth M. Zeisberg, Miriam Puls, Claudius Jacobshagen, Martin Uecker, Gerd Hasenfuß, Andreas Schuster

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2020

Abstract

Background

Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiovascular magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been compared against standard techniques and histology.

Methods

Patients with severe AS underwent CMR before (n = 110) and left ventricular (LV) endomyocardial biopsy (n = 46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis (SAX) native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available modified Look-Locker Inversion recovery (MOLLI) (native: 5(3)3, post-contrast: 4(1)3(1)2) and RT single-shot inversion recovery Fast Low-Angle Shot (FLASH) with radial undersampling. Focal late gadolinium enhancement was excluded from T1 and ECV regions of interest. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses.

Results

RT and MOLLI derived ECV were similar for midventricular SAX slice coverage (26.2 vs. 26.5, p = 0.073) and septal region of interest (26.2 vs. 26.5, p = 0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p < 0.001). Agreement between RT and MOLLI was best for ECV (ICC > 0.91), excellent for post-contrast T1 times (ICC > 0.81) and good for native T1 times (ICC > 0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r = 0.345, p = 0.039; MOLLI r = 0.40, p = 0.010) and LV matrix volumes (RT r = 0.45, p = 0.005; MOLLI r = 0.43, p = 0.007) were the only parameters associated with histology.

Conclusions

RT mapping offers fast and sufficient ECV and LV matrix volume calculation in AS patients. ECV and LV matrix volume represent robust and universally comparable parameters with associations to histologically assessed fibrosis and may emerge as potential targets for clinical decision making.

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Title: Real-time cardiovascular magnetic resonance T1 and extracellular volume fraction mapping for tissue characterisation in aortic stenosis
Authors: Sören J. Backhaus
Torben Lange
Bo Eric Beuthner
Rodi Topci
Xiaoqing Wang
Johannes T. Kowallick
Joachim Lotz
Tim Seidler
Karl Toischer
Elisabeth M. Zeisberg
Miriam Puls
Claudius Jacobshagen
Martin Uecker
Gerd Hasenfuß
Andreas Schuster
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Aortic Valve Replacement
Aortic Valve Replacement
Aortic Valve Replacement
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2020
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-020-00632-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Real-time cardiovascular magnetic resonance T1 and extracellular volume fraction mapping for tissue characterisation in aortic stenosis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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