Key result
Patients with hypertrophic cardiomyopathy without late gadolinium enhancement had significantly prolonged native myocardial T1 (950 vs 913 msec) and elevated extracellular volume (24.5% vs 23.0%) compared to healthy participants.
Why the study?
The value of native myocardial T1 mapping and ECV fraction in patients with HCM without LGE and without hemodynamic obstruction is unknown.
Does cardiac MRI with native T1 mapping and ECV fraction detect diffuse myocardial fibrosis in patients with nonobstructive hypertrophic cardiomyopathy without late gadolinium enhancement compared to healthy participants?
Observational (n=380)
Blinded image analysis
No
Does cardiac MRI with native T1 mapping and ECV fraction detect diffuse myocardial fibrosis in patients with nonobstructive hypertrophic cardiomyopathy without late gadolinium enhancement compared to healthy participants?
Native T1 mapping and ECV fraction can detect diffuse myocardial fibrosis in nonobstructive HCM patients even before late gadolinium enhancement becomes apparent, correlating strongly with LV hypertrophy.
Answers are grounded in this paper and cite their sources.
T1/ECV may detect early diffuse fibrosis in nonobstructive HCM without LGE; leaves open prognostic value and management impact.
Background The value of native myocardial T1 mapping and extracellular volume (ECV) fraction in patients who have hypertrophic cardiomyopathy (HCM) but no late gadolinium enhancement (LGE) and no hemodynamic obstruction are currently unknown. Purpose To evaluate myocardial fibrosis in patients with nonobstructive HCM and no LGE by using native myocardial T1 mapping and ECV fraction and to study their relationships to left ventricular (LV) function and LV hypertrophy. Materials and Methods Patients with HCM who underwent cardiac MRI between 2012 and 2015 were retrospectively evaluated. Patients were included if they had no LGE at MRI, LV ejection fraction greater than or equal to 45%, and no LV outflow tract obstruction. Healthy participants had similar age and sex distribution. Native myocardial T1 and ECV were measured with MRI. Results A total of 258 patients with HCM (mean age ± standard deviation, 49 years ± 15; 74% men) and 122 healthy participants (mean age, 50 years ± 14; 76% men) were evaluated. Native myocardial T1 was longer and ECV fraction was higher in the patients with HCM relative to the healthy participants (mean native T1, 950 msec ± 48 vs 913 msec ± 46; mean ECV, 24.5% ± 2.8 vs 23.0% ± 2.7; both P < .001). Maximum T1 and ECV values correlated strongly with LV mass index for the entire patient cohort with HCM (both r = 0.86; P < .001) and for the subgroups (r = 0.86 and 0.85 for interventricular septal group and r = 0.88 and 0.86 for apical group; all P < .001). Conclusion Prolonged myocardial T1 and elevated extracellular volume in hypertrophic cardiomyopathy suggests diffuse myocardial fibrosis, even in the absence of regionally apparent late gadolinium enhancement and hemodynamic obstruction, and is associated with left ventricular hypertrophy.
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Xu et al. (2019) conducted an observational in Hypertrophic cardiomyopathy without late gadolinium enhancement (n=380). Hypertrophic cardiomyopathy without late gadolinium enhancement vs. Healthy participants was evaluated on Native myocardial T1 (msec) (p=<0.001). Patients with hypertrophic cardiomyopathy without late gadolinium enhancement had significantly prolonged native myocardial T1 (950 vs 913 msec) and elevated extracellular volume (24.5% vs 23.0%) compared to healthy participants.
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