Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2018 | Research

Extracellular volume fraction measurements derived from the longitudinal relaxation of blood-based synthetic hematocrit may lead to clinical errors in 3 T cardiovascular magnetic resonance

Authors: Yongning Shang, Xiaochun Zhang, Xiaoyue Zhou, Jian Wang

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2018

Abstract

Background

The extracellular volume (ECV), derived from cardiovascular magnetic resonance (CMR) T1 mapping, is a biomarker of the extracellular space in the myocardium. The hematocrit (HCT), measured from venipuncture, is required for ECV measurement. We test the clinic values of synthetic ECV, which is derived from the longitudinal relaxation of blood–based (T1_blood) synthetic hematocrit in 3 T CMR.

Methods

A total of 226 subjects with CMR T1 mapping and HCT measurement taken on the same day as the CMR were retrospectively enrolled and randomly split into derivation (n = 121) and validation (n = 105) groups, comprising healthy subjects (n = 45), type 2 diabetes mellitus (T2DM) patients (n = 60), hypertrophic cardiomyopathy (HCM) patients (n = 93), and 28 other patients. Correlation of T1_blood with the measured HCT (HCTm) was established in the derivation group and used in both the derivation and the validation groups. The relationships between the ECV values derived from both the synthetic HCT (HCTsyn) and HCTm were explored. In addition, the differences in the ECV values among the HC, T2DMs, and HCMs were compared.

Results

Regression between the HCTm and 1/T1_blood was linear (R² = 0.19, p < 0.001), and the regression equation was: HCTsyn = [561.6*(1/T1blood)] + 0.098 in the derivation group. The measured ECV (ECVm) was strongly correlated with the synthetic ECV (ECVsyn) (R² = 0.87, p < 0.001) and mildly correlated with the difference between the ECVsyn and ECVm (R² = 0.10, p < 0.001) in the derivation group. Also in this group, the ECVm was larger in T2DMs than that in healthy cohort (29.1 ± 3.1% vs. 26.4 ± 2.4%, p = 0.002), whereas, the ECVsyn did not differ between T2DMs and healthy cohort (28.3 ± 2.9% vs. 26.9 ± 2.2%, p = 0.064). Compared with the healthy cohort, the HCMs were associated with higher ECVsyn and ECVm of the mid-ventricle in both the derivation and the validation groups. Using our center’s normal cut-off of 31.8%, the use of ECVsyn would lead to a 6–25% incorrect categorization of patients in the derivation and validation groups.

Conclusions

ECVsyn derived from HCTsyn may lead to clinical errors in 3 T CMR, especially for patients who have only a subtle elevation in ECV.

Available only for authorised users

Schelbert EB, Messroghli DR. State of the art: clinical applications of cardiac T1 mapping. Radiology. 2016;278(3):658–76.CrossRefPubMed

Diao KY, Yang ZG, Xu HY, Liu X, Zhang Q, Shi K, Jiang L, Xie LJ, Wen LY, Guo YK. Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. J Cardiovasc Magn Reson. 2016;18(1):92.CrossRefPubMedPubMedCentral

Banypersad SM, Fontana M, Maestrini V, Sado DM, Captur G, Petrie A, Piechnik SK, Whelan CJ, Herrey AS, Gillmore JD, et al. T1 mapping and survival in systemic light-chain amyloidosis. Eur Heart J. 2015;36(4):244–51.CrossRefPubMed

Martinez-Naharro A, Treibel TA, Abdel-Gadir A, Bulluck H, Zumbo G, Knight DS, Kotecha T, Francis R, Hutt DF, Rezk T, et al. Magnetic resonance in transthyretin cardiac amyloidosis. J Am Coll Cardiol. 2017;70(4):466–77.CrossRefPubMed

Wong TC, Piehler K, Meier CG, Testa SM, Klock AM, Aneizi AA, Shakesprere J, Kellman P, Shroff SG, Schwartzman DS, et al. Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation. 2012;126(10):1206–16.CrossRefPubMedPubMedCentral

Wong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, Mulukutla SR, Simon MA, Shroff SG, Kuller LH, et al. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J. 2014;35(10):657–64.CrossRefPubMed

Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P, Mascherbauer J, Nezafat R, Salerno M, Schelbert EB, et al. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson. 2017;19(1):75.CrossRefPubMedPubMedCentral

Treibel TA, Fontana M, Maestrini V, Castelletti S, Rosmini S, Simpson J, Nasis A, Bhuva AN, Bulluck H, Abdel-Gadir A, et al. Automatic measurement of the myocardial Interstitium. J Am Coll Cardiol Img. 2016;9(1):54–63.CrossRef

Fent GJ, Garg P, Foley JRJ, Swoboda PP, Dobson LE, Erhayiem B, Treibel TA, Moon JC, Greenwood JP, Plein S. Synthetic myocardial extracellular volume fraction. JACC Cardiovasc Imaging. 2017;10(11):1402–4.CrossRefPubMed

10.

Raucci FJ Jr, Parra DA, Christensen JT, Hernandez LE, Markham LW, Xu M, Slaughter JC, Soslow JH. Synthetic hematocrit derived from the longitudinal relaxation of blood can lead to clinically significant errors in measurement of extracellular volume fraction in pediatric and young adult patients. J Cardiovasc Magn Reson. 2017;19(1):58.CrossRefPubMedPubMedCentral

11.

Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.CrossRefPubMed

12.

Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kuhl U, Maisch B, McKenna WJ, et al. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2008;29(2):270–6.CrossRefPubMed

13.

Fleming C, Brouwer R, Lindemans J, de Jonge R. Validation of the body fluid module on the new Sysmex XN-1000 for counting blood cells in cerebrospinal fluid and other body fluids. Clin Chem Lab Med. 2012;50(10):1791–8.CrossRefPubMed

14.

Villanueva A, Hoshida Y, Battiston C, Tovar V, Sia D, Alsinet C, Cornella H, Liberzon A, Kobayashi M, Kumada H, et al. Combining clinical, pathology, and gene expression data to predict recurrence of hepatocellular carcinoma. Gastroenterology. 2011;140(5):1501–12.CrossRefPubMedPubMedCentral

15.

Liu CY, Liu YC, Wu C, Armstrong A, Volpe GJ, van der Geest RJ, Liu Y, Hundley WG, Gomes AS, Liu S, et al. Evaluation of age-related interstitial myocardial fibrosis with cardiac magnetic resonance contrast-enhanced T1 mapping: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol. 2013;62(14):1280–7.CrossRefPubMed

16.

Rommel KP, von Roeder M, Latuscynski K, Oberueck C, Blazek S, Fengler K, Besler C, Sandri M, Lucke C, Gutberlet M, et al. Extracellular volume fraction for characterization of patients with heart failure and preserved ejection fraction. J Am Coll Cardiol. 2016;67(15):1815–25.CrossRefPubMed

17.

Lu H, Clingman C, Golay X, van Zijl PC. Determining the longitudinal relaxation time (T1) of blood at 3.0 tesla. Magn Reson Med. 2004;52(3):679–82.CrossRefPubMed

18.

Shimada K, Nagasaka T, Shidahara M, Machida Y, Tamura H. In vivo measurement of longitudinal relaxation time of human blood by inversion-recovery fast gradient-echo MR imaging at 3T. Magn Reson Med Sci. 2012;11(4):265–71.CrossRefPubMed

19.

Bulluck H, Maestrini V, Rosmini S, Abdel-Gadir A, Treibel TA, Castelletti S, Bucciarelli-Ducci C, Manisty C, Moon JC. Myocardial T1 mapping. Circ J. 2015;79(3):487–94.CrossRefPubMed

20.

Haaf P, Garg P, Messroghli DR, Broadbent DA, Greenwood JP, Plein S. Cardiac T1 mapping and extracellular volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson. 2016;18(1):89.CrossRefPubMedPubMedCentral

21.

Shang Y, Zhang X, Leng W, Chen L, Lei X, Zhang T, Greiser A, Liang Z, Wang J. Assessment of diabetic cardiomyopathy by cardiovascular magnetic resonance T1 mapping: correlation with left-ventricular diastolic dysfunction and diabetic duration. J Diab Res. 2017;2017:1–8.CrossRef

Title: Extracellular volume fraction measurements derived from the longitudinal relaxation of blood-based synthetic hematocrit may lead to clinical errors in 3 T cardiovascular magnetic resonance
Authors: Yongning Shang
Xiaochun Zhang
Xiaoyue Zhou
Jian Wang
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2018
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-018-0475-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Extracellular volume fraction measurements derived from the longitudinal relaxation of blood-based synthetic hematocrit may lead to clinical errors in 3 T cardiovascular magnetic resonance

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy – a prospective clinical cardiovascular magnetic resonance trial

Cardiovascular magnetic resonance imaging in the prospective, population-based, Hamburg City Health cohort study: objectives and design

Cardiovascular magnetic resonance guided ablation and intra-procedural visualization of evolving radiofrequency lesions in the left ventricle

Relationship between CMR-derived parameters of ischemia/reperfusion injury and the timing of CMR after reperfused ST-segment elevation myocardial infarction

Simultaneous multi slice (SMS) balanced steady state free precession first-pass myocardial perfusion cardiovascular magnetic resonance with iterative reconstruction at 1.5 T

Guidelines for training in cardiovascular magnetic resonance (CMR)