Potential of non-contrast stress T1 mapping for the assessment of myocardial injury in hypertrophic cardiomyopathy

Hisanori Kosuge; Shoko Hachiya; Yasuhiro Fujita; Satoshi Hida; Taishiro Chikamori

doi:10.1186/s12968-023-00966-5

Potential of non-contrast stress T1 mapping for the assessment of myocardial injury in hypertrophic cardiomyopathy

J Cardiovasc Magn Reson. 2023 Sep 28;25(1):53. doi: 10.1186/s12968-023-00966-5.

Authors

Hisanori Kosuge¹, Shoko Hachiya², Yasuhiro Fujita², Satoshi Hida², Taishiro Chikamori²

Affiliations

¹ Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. hkosuge@tokyo-med.ac.jp.
² Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Abstract

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.

Keywords: Coronary flow reserve; Hypertrophic cardiomyopathy; Myocardial injury; T1 mapping.

MeSH terms

Adenosine Triphosphate
Cardiomyopathy, Hypertrophic* / diagnostic imaging
Contrast Media*
Gadolinium
Humans
Predictive Value of Tests

Substances

Contrast Media
Gadolinium
Adenosine Triphosphate