What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=54). Intervention: Heart failure vs. Controls. Primary outcome: Post-contrast myocardial T1 time (p=<0.0001).

June 5, 2026

Evaluation of Diffuse Myocardial Fibrosis in Heart Failure With Cardiac Magnetic Resonance Contrast-Enhanced T1 Mapping

Q: What are the key findings of this study?

Heart failure patients had significantly shorter post-contrast myocardial T1 times compared to controls (383 vs 564 ms, p<0.0001), reflecting diffuse myocardial fibrosis.

Q: What question did this study set out to answer?

The study aims to explore a noninvasive method for quantifying diffuse myocardial fibrosis in heart failure using CMRI.

Key Result

Heart failure patients had significantly shorter post-contrast myocardial T1 times compared to controls (383 vs 564 ms, p<0.0001), reflecting diffuse myocardial fibrosis.

Key Points

The study aims to explore a noninvasive method for quantifying diffuse myocardial fibrosis in heart failure using CMRI.
Conducted CMRI on 45 subjects (25 heart failure patients, 20 controls) using a prototype T(1) mapping sequence.
Calculated post-contrast myocardial T(1) times to assess diffuse fibrosis, and evaluated systolic and diastolic function with cine CMRI and echocardiography.
Nine additional subjects underwent endomyocardial biopsy for histologic correlation.
Post-contrast myocardial T(1) times were significantly shorter in heart failure subjects (383 +/- 17 ms) compared to controls (564 +/- 23 ms, p < 0.0001).
T(1) times in heart failure myocardium remained shorter than controls even when excluding regional fibrosis (429 +/- 22 ms vs. 564 +/- 23 ms, p < 0.0001).
T(1) time decreased with worsening diastolic function: 562 +/- 24 ms in normal function to 368 +/- 20 ms in restrictive function (p < 0.001).

Study Design

Type

Observational (n=54)

Structured PICO

Does contrast-enhanced CMRI T1 mapping accurately quantify diffuse myocardial fibrosis in patients with heart failure compared to controls?

Population

54 subjects, including 25 with heart failure, 20 controls, and 9 for histologic correlation, evaluated with contrast-enhanced CMRI T1 mapping.

Exposure

Contrast-enhanced cardiac magnetic resonance imaging (CMRI) with a prototype T1 mapping sequence

Comparator

Control patients without heart failure

Outcome

Post-contrast myocardial T1 time as an index of diffuse fibrosissurrogate

Contrast-enhanced CMRI T1 mapping provides a noninvasive method to quantify diffuse myocardial fibrosis, which correlates with histologic findings and diastolic dysfunction in heart failure.

Main Result

Absolute Event Rate: 383% vs 564%

p-value: p=<0.0001

Abstract

OBJECTIVES: The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI). BACKGROUND: Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis. METHODS: We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T(1) mapping sequence was used to calculate the post-contrast myocardial T(1) time as an index of diffuse fibrosis; regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation. RESULTS: Post-contrast myocardial T(1) times correlated histologically with fibrosis (R = -0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 +/- 17 ms vs. 564 +/- 23 ms, p < 0.0001). The T(1) time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 +/- 22 ms vs. 564 +/- 23 ms, p < 0.0001). The post-contrast myocardial T(1) time shortened as diastolic function worsened (562 +/- 24 ms in normal diastolic function vs. 423 +/- 33 ms in impaired diastolic function vs. 368 +/- 20 ms in restrictive function, p < 0.001). CONCLUSIONS: Contrast-enhanced CMRI T(1) mapping identifies changes in myocardial T(1) times in heart failure, which appear to reflect diffuse fibrosis.

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