June 29, 2010Open Access
View Full PaperEquilibrium Contrast Cardiovascular Magnetic Resonance for the Measurement of Diffuse Myocardial Fibrosis
Structured PICO
Does EQ-CMR accurately quantify diffuse myocardial fibrosis compared to surgical myocardial biopsy in patients with aortic stenosis or hypertrophic cardiomyopathy?
P
Population
26 patients undergoing aortic valve replacement for aortic stenosis (n=18) or myectomy in hypertrophic cardiomyopathy (n=8).
I
Intervention
Equilibrium contrast CMR (EQ-CMR) using a bolus of extracellular gadolinium contrast followed by continuous infusion, blood sampling for hematocrit, and pre- and postequilibrium T1 measurement.
C
Comparator
Surgical myocardial biopsy with picrosirius red fibrosis quantification on histology.
O
Outcome
Correlation between EQ-CMR myocardial volume of distribution and histological fibrosis.surrogate
EQ-CMR is a novel, noninvasive technique that accurately quantifies diffuse myocardial fibrosis, correlating strongly with the gold standard of surgical biopsy.
Abstract
BACKGROUND: Diffuse myocardial fibrosis is a final end point in most cardiac diseases. It is missed by the cardiovascular magnetic resonance (CMR) late gadolinium enhancement technique. Currently, quantifying diffuse myocardial fibrosis requires invasive biopsy, with inherent risk and sampling error. We have developed a robust and noninvasive technique, equilibrium contrast CMR (EQ-CMR) to quantify diffuse fibrosis and have validated it against the current gold standard of surgical myocardial biopsy. METHODS AND RESULTS: The 3 principles of EQ-CMR are a bolus of extracellular gadolinium contrast followed by continuous infusion to achieve equilibrium; a blood sample to measure blood volume of distribution (1-hematocrit); and CMR to measure pre- and postequilibrium T1 (with heart rate correction). The myocardial volume of distribution is calculated, reflecting diffuse myocardial fibrosis. Clinical validation occurred in patients undergoing aortic valve replacement for aortic stenosis or myectomy in hypertrophic cardiomyopathy (n=18 and n=8, respectively). Surgical biopsies were analyzed for picrosirius red fibrosis quantification on histology. The mean histological fibrosis was 20.5+/-11% in aortic stenosis and 17.1+/-7.4% in hypertrophic cardiomyopathy. EQ-CMR correlated strongly with biopsy histological fibrosis: aortic stenosis, r(2)=0.86, Kendall Tau coefficient (T)=0.71, P<0.001; hypertrophic cardiomyopathy, r(2)=0.62, T=0.52, P=0.08; combined r(2)=0.80, T=0.67, P<0.001. CONCLUSIONS: We have developed and validated a new technique, EQ-CMR, to measure diffuse myocardial fibrosis as an add-on to a standard CMR scan, which allows for the noninvasive quantification of the diffuse fibrosis burden in myocardial diseases.