Magnetic resonance imaging reference values for cardiac morphology, function and tissue composition in adolescents

Carlos Real; Rocío Párraga; Gonzalo Pizarro; Inés García-Lunar; Ernesto González-Calvo; Jesús Martínez-Gómez; Javier Sánchez-González; Patricia Sampedro; Irene Sanmamed; Mercedes De Miguel; Amaya De Cos-Gandoy; Patricia Bodega; Borja Ibanez; Gloria Santos-Beneit; Valentin Fuster; Rodrigo Fernández-Jiménez

doi:10.1016/j.eclinm.2023.101885

Magnetic resonance imaging reference values for cardiac morphology, function and tissue composition in adolescents

EClinicalMedicine. 2023 Mar 3:57:101885. doi: 10.1016/j.eclinm.2023.101885. eCollection 2023 Mar.

Authors

Carlos Real^{1

2}, Rocío Párraga^{1

2}, Gonzalo Pizarro^{1

3

4}, Inés García-Lunar^{1

4

5}, Ernesto González-Calvo^{1

2}, Jesús Martínez-Gómez¹, Javier Sánchez-González⁶, Patricia Sampedro¹, Irene Sanmamed¹, Mercedes De Miguel^{1

7}, Amaya De Cos-Gandoy^{1

7}, Patricia Bodega^{1

7}, Borja Ibanez^{1

4

8}, Gloria Santos-Beneit^{7

9}, Valentin Fuster^{1

9}, Rodrigo Fernández-Jiménez^{1

2

4}

Affiliations

¹ Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
² Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
³ Department of Cardiology, Hospital Ruber Juan Bravo Quironsalud UEM, Madrid, Spain.
⁴ CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain.
⁵ Cardiology Department, University Hospital La Moraleja, Madrid, Spain.
⁶ Philips Healthcare Spain, Madrid, Spain.
⁷ Foundation for Science, Health and Education (SHE), Barcelona, Spain.
⁸ Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain.
⁹ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.

Abstract

Background: Cardiovascular magnetic resonance (CMR) is a precise tool for the assessment of cardiac anatomy, function, and tissue composition. However, studies providing CMR reference values in adolescence are scarce. We aim to provide sex-specific CMR reference values for biventricular and atrial dimensions and function and myocardial relaxation times in this population.

Methods: Adolescents aged 15-18 years with no known cardiovascular disease underwent a non-contrast 3-T CMR scan between March 2021 and October 2021. The imaging protocol included a cine steady-state free-precession sequence for the analysis of chamber size and function, as well as T2-GraSE and native MOLLI T1-mapping for the characterization of myocardial tissue.

Findings: CMR scans were performed in 123 adolescents (mean age 16 ± 0.5 years, 52% girls). Mean left and right ventricular end-diastolic indexed volumes were higher in boys than in girls (91.7 ± 11.6 vs 78.1 ± 8.3 ml/m², p < 0.001; and 101.3 ± 14.1 vs 84.1 ± 10.5 ml/m², p < 0.001), as was the indexed left ventricular mass (48.5 ± 9.6 vs 36.6 ± 6.0 g/m², p < 0.001). Left ventricular ejection fraction showed no significant difference by sex (62.2 ± 4.1 vs 62.8 ± 4.2%, p = 0.412), whereas right ventricular ejection fraction trended slightly lower in boys (55.4 ± 4.7 vs. 56.8 ± 4.4%, p = 0.085). Indexed atrial size and function parameters did not differ significantly between sexes. Global myocardial native T1 relaxation time was lower in boys than in girls (1215 ± 23 vs 1252 ± 28 ms, p < 0.001), whereas global myocardial T2 relaxation time did not differ by sex (44.4 ± 2.0 vs 44.1 ± 2.4 ms, p = 0.384). Sex-stratified comprehensive percentile tables are provided for most relevant cardiac parameters.

Interpretation: This cross-sectional study provides overall and sex-stratified CMR reference values for cardiac dimensions and function, and myocardial tissue properties, in adolescents. This information is useful for clinical practice and may help in the differential diagnosis of cardiac diseases, such as cardiomyopathies and myocarditis, in this population.

Funding: Instituto de Salud Carlos III (PI19/01704).

Keywords: Adolescent; Differential diagnosis; Magnetic resonance; Pediatrics; Reference values; Ventricular function.