Defining myocardial tissue abnormalities in end-stage renal failure with cardiac magnetic resonance imaging using native T1 mapping

Noninvasive quantification of myocardial fibrosis in end-stage renal disease is challenging. Gadolinium contrast agents previously used for cardiac magnetic resonance imaging (MRI) are contraindicated because of an association with nephrogenic systemic fibrosis. In other populations, increased myocardial native T1 times on cardiac MRI have been shown to be a surrogate marker of myocardial fibrosis. We applied this method to 33 incident hemodialysis patients and 28 age- and sex-matched healthy volunteers who underwent MRI at 3.0T. Native T1 relaxation times and feature tracking–derived global longitudinal strain as potential markers of fibrosis were compared and associated with cardiac biomarkers. Left ventricular mass indices were higher in the hemodialysis than the control group. Global, Septal and midseptal T1 times were all significantly higher in the hemodialysis group (global T1 hemodialysis 1171 ± 27 ms vs. 1154 ± 32 ms; septal T1 hemodialysis 1184 ± 29 ms vs. 1163 ± 30 ms; and midseptal T1 hemodialysis 1184 ± 34 ms vs. 1161 ± 29 ms). In the hemodialysis group, T1 times correlated with left ventricular mass indices. Septal T1 times correlated with troponin and electrocardiogram-corrected QT interval. The peak global longitudinal strain was significantly reduced in the hemodialysis group (hemodialysis -17.7±5.3% vs. -21.8±6.2%). For hemodialysis patients, the peak global longitudinal strain significantly correlated with left ventricular mass indices (R = 0.426), and a trend was seen for correlation with galectin-3, a biomarker of cardiac fibrosis. Thus, cardiac tissue properties of hemodialysis patients consistent with myocardial fibrosis can be determined noninvasively and associated with multiple structural and functional abnormalities. Noninvasive quantification of myocardial fibrosis in end-stage renal disease is challenging. Gadolinium contrast agents previously used for cardiac magnetic resonance imaging (MRI) are contraindicated because of an association with nephrogenic systemic fibrosis. In other populations, increased myocardial native T1 times on cardiac MRI have been shown to be a surrogate marker of myocardial fibrosis. We applied this method to 33 incident hemodialysis patients and 28 age- and sex-matched healthy volunteers who underwent MRI at 3.0T. Native T1 relaxation times and feature tracking–derived global longitudinal strain as potential markers of fibrosis were compared and associated with cardiac biomarkers. Left ventricular mass indices were higher in the hemodialysis than the control group. Global, Septal and midseptal T1 times were all significantly higher in the hemodialysis group (global T1 hemodialysis 1171 ± 27 ms vs. 1154 ± 32 ms; septal T1 hemodialysis 1184 ± 29 ms vs. 1163 ± 30 ms; and midseptal T1 hemodialysis 1184 ± 34 ms vs. 1161 ± 29 ms). In the hemodialysis group, T1 times correlated with left ventricular mass indices. Septal T1 times correlated with troponin and electrocardiogram-corrected QT interval. The peak global longitudinal strain was significantly reduced in the hemodialysis group (hemodialysis -17.7±5.3% vs. -21.8±6.2%). For hemodialysis patients, the peak global longitudinal strain significantly correlated with left ventricular mass indices (R = 0.426), and a trend was seen for correlation with galectin-3, a biomarker of cardiac fibrosis. Thus, cardiac tissue properties of hemodialysis patients consistent with myocardial fibrosis can be determined noninvasively and associated with multiple structural and functional abnormalities. Premature cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD). Excessive cardiac mortality is thought to be secondary to nonatherosclerotic processes, with sudden cardiac death being a predominant feature.1Baigent C. Burbury K. Wheeler D. Premature cardiovascular disease in chronic renal failure.Lancet. 2000; 356: 147-152Abstract Full Text Full Text PDF PubMed Scopus (495) Google Scholar, 2Herzog C.A. Asinger R.W. Berger A.K. et al.Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO).Kidney Int. 2011; 80: 572-586Abstract Full Text Full Text PDF PubMed Scopus (621) Google Scholar Left ventricular hypertrophy (LVH) is common in these patients and is convincingly associated with cardiovascular and all-cause mortality.3Silberberg J.S. Barre P.E. Prichard S.S. Sniderman A.D. 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Full Text Full Text PDF PubMed Scopus Google Scholar increased myocardial native T1 times have been demonstrated in early M. et interstitial fibrosis and myocardial in early chronic kidney J Cardiol. 2015; Full Text Full Text PDF PubMed Scopus Google Scholar now the assessment of native T1 times in ESRD and their with in a normal healthy population has been T1 times are in the ESRD population than in healthy to be a marker of cardiac fibrosis in the renal the of myocardial fibrosis be an and for renal clinical In this we compared native myocardial global and septal T1 relaxation times as potential markers of diffuse myocardial fibrosis in incident patients with of healthy volunteers fraction is late the development of R.N. P.S. J.D. et and disease in patients end-stage renal disease Int. 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S. et of myocardial fibrosis: the for a Am Cardiol. 2015; Full Text Full Text PDF PubMed Scopus Google Scholar We the between CMR cardiac and other the markers of increased cardiac and troponin A of and sex-matched were 28 and 33 patients. of the population and the of cardiovascular risk factors in this group are shown in The cardiovascular systemic disease and a normal were for and were use by the patients and for = renal diagnosis kidney of time on ± volume ± heart disease disease and values were for and values were for was for 28 as of ± as and values were for was for 28 in a in the = shown as of in a as of ± as shown as of Left ventricular mass was significantly in the the mass to in the group was the group One in the group as an for and for K. S. H. et left and ventricular for MRI as by and imaging Magn Imaging. 17: PubMed Scopus Google Scholar In the group, of all = fraction was between the in the group dysfunction, as an fraction K. S. H. et left and ventricular for MRI as by and imaging Magn Imaging. 17: PubMed Scopus Google Scholar compared with in the group = and were between the Full cardiac of are in and Cardiac of and = = T1 ± T1 ± ± T1 ± ± ± ± ± ± ± ± ± ± ± ± ± ± mass early strain volume to volume to global longitudinal dilation, left ventricular LVH, left ventricular left ventricular left ventricular mass to left ventricular are shown as ± of as in a mass early strain volume to volume to global longitudinal dilation, left ventricular LVH, left ventricular left ventricular left ventricular mass to left ventricular are shown as ± of as Global T1 time and septal and midseptal T1 times were in the group compared with the group global T1 time in the group, 1171 ± 27 ms the group, 1154 ± 32 = septal T1 time in the group, 1184 ± 29 ms the group, 1163 ± 30 = midseptal T1 time in the group, 1184 ± 34 ms the group, 1161 ± 29 = In the group, correlated with all of T1 for global T1 with an = = for septal T1 with an = = for midseptal T1 with an = = Septal T1 times correlated with for global T1 = = for septal T1 = = for midseptal T1 = = T1 times to was reduced in the group compared with the group ± vs. group, ± = In the group, correlated with = = and correlated with fraction = = In the group, correlated with volume = = is associated with a in R.N. P.S. J.D. et of left ventricular in uremic Am Soc Nephrol. 5: Google Scholar a of early CKD using feature tracking–derived strain M. et interstitial fibrosis and myocardial in early chronic kidney J Cardiol. 2015; Full Text Full Text PDF PubMed Scopus Google Scholar we found in early strain strain between the and was correlation between any marker of strain and native T1 values. 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