Key result
Non-contrast stress T1 mapping revealed that T1 reactivity was significantly lower in patients with hypertrophic cardiomyopathy compared to control subjects (4.2% vs. 5.6%, p=0.044).
Why the study?
Ischemia from microvascular dysfunction portends worse prognosis in HCM, and the potential of non-contrast stress T1 mapping to assess myocardial injury had not been evaluated.
Does non-contrast stress T1 mapping detect myocardial injury in patients with hypertrophic cardiomyopathy?
Case-Control (n=45)
Single-blind
No
Does non-contrast stress T1 mapping detect myocardial injury in patients with hypertrophic cardiomyopathy?
Absolute Event Rate: 4.2% vs 5.6%
p-value: p=0.044
Non-contrast stress T1 mapping is a promising contrast-free CMR method for assessing myocardial injury and microvascular dysfunction in patients with hypertrophic cardiomyopathy.
Non-contrast stress T1 mapping may support noninvasive injury assessment in HCM; leaves open validation in larger prospective cohorts before clinical adoption.
BACKGROUND: Ischemia of the hypertrophied myocardium due to microvascular dysfunction is related to a worse prognosis in hypertrophic cardiomyopathy (HCM). Stress and rest T1 mapping without contrast agents can be used to assess myocardial blood flow. Herein, we evaluated the potential of non-contrast stress T1 mapping in assessing myocardial injury in patients with HCM. METHODS: Forty-five consecutive subjects (31 HCM patients and 14 control subjects) underwent cardiac magnetic resonance (CMR) at 3T, including cine imaging, T1 mapping at rest and during adenosine triphosphate (ATP) stress, late gadolinium enhancement (LGE), and phase-contrast (PC) cine imaging of coronary sinus flow at rest and during stress to assess coronary flow reserve (CFR). PC cine imaging was performed on 25 subjects (17 patients with HCM and 8 control subjects). Native T1 values at rest and during stress were measured using the 16-segment model, and T1 reactivity was defined as the change in T1 values from rest to stress. RESULTS: ATP stress induced a significant increase in native T1 values in both the HCM and control groups (HCM: p < 0.001, control: p = 0.002). T1 reactivity in the HCM group was significantly lower than that in the control group (4.2 ± 0.3% vs. 5.6 ± 0.5%, p = 0.044). On univariate analysis, T1 reactivity correlated with native T1 values at rest, left ventricular mass index, and CFR. Multiple linear regression analysis demonstrated that only CFR was independently correlated with T1 reactivity (β = 0.449; 95% confidence interval, 0.048-0.932; p = 0.032). Furthermore, segmental analysis showed decreased T1 reactivity in the hypertrophied myocardium and the non-hypertrophied myocardium with LGE in the HCM group. CONCLUSIONS: T1 reactivity was lower in the hypertrophied myocardium and LGE-positive myocardium compared to non-injured myocardium. Non-contrast stress T1 mapping is a promising CMR method for assessing myocardial injury in patients with HCM. Trial registration Retrospectively registered.
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Kosuge et al. (2023) conducted a case-control in Hypertrophic cardiomyopathy (n=45). Hypertrophic cardiomyopathy vs. Control subjects was evaluated on T1 reactivity (change in T1 values from rest to stress) (p=0.044). Non-contrast stress T1 mapping revealed that T1 reactivity was significantly lower in patients with hypertrophic cardiomyopathy compared to control subjects (4.2% vs. 5.6%, p=0.044).
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