Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　- Comparison With Targeted Left Ventricular Myocardial Biopsy.

BACKGROUND The aim of our study was to investigate the relationship between the cardiac magnetic resonance (CMR)-derived native T1 relaxation time and myocardial extracellular volume (ECV) fraction and the extent of diffuse myocardial fibrosis (DMF) on targeted myocardial left ventricular (LV) biopsy. METHODSANDRESULTS The study population consisted of 40 patients (age 63±8 years, 65% male) undergoing valve and/or ascending aorta surgery for severe aortic stenosis (77.5%), root dilatation (7.5%) or valve regurgitation (15%). The T1 relaxation time was assessed in the basal interventricular septum pre- and 10-min post-contrast administration using the modified Look-Locker Inversion recovery sequence prior to surgery. LV myocardial biopsy specimen was obtained during surgery from the basal interventricular septal segment matched with the T1 mapping assessment. The percentage of myocardial collagen was quantified using picrosirius red staining. The average percentage of myocardial collagen was 22.0±14.8%. Both native T1 relaxation time with cutoff value ≥1,010 ms (sensitivity=90%, specificity=73%, area under the curve=0.82) and ECV with cutoff value ≥0.32 (sensitivity=80%, specificity=90%, area under the curve=0.85) showed high accuracy to identify severe (>30%) DMF. The native T1 relaxation time showed significant correlation with LV mass (P<0.01). CONCLUSIONS Native T1 relaxation time and ECV at 10 min after contrast administration are accurate markers of DMF. (Circ J 2016; 80: 1202-1209).

[1]  D. Callans,et al.  Role of Cardiac Magnetic Resonance Imaging in the Management and Treatment of Ventricular Tachycardia in Patients With Structural Heart Disease. , 2015, Circulation journal : official journal of the Japanese Circulation Society.

[2]  K. Hayashi,et al.  Increased extent of myocardial fibrosis in genotyped hypertrophic cardiomyopathy with ventricular tachyarrhythmias. , 2015, Journal of cardiology.

[3]  B. Gerber,et al.  Histological Validation of measurement of diffuse interstitial myocardial fibrosis by myocardial extravascular volume fraction from Modified Look-Locker imaging (MOLLI) T1 mapping at 3 T , 2015, Journal of Cardiovascular Magnetic Resonance.

[4]  James C Moon,et al.  Myocardial T1 mapping. , 2015, Circulation journal : official journal of the Japanese Circulation Society.

[5]  Yong-Jin Kim,et al.  Assessment of diffuse myocardial fibrosis by using MR imaging in asymptomatic patients with aortic stenosis. , 2015, Radiology.

[6]  T. Sundt,et al.  2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[7]  Thoralf M Sundt,et al.  2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Journal of the American College of Cardiology.

[8]  P. Kellman,et al.  T1-mapping in the heart: accuracy and precision , 2014, Journal of Cardiovascular Magnetic Resonance.

[9]  Tevfik F Ismail,et al.  Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. , 2013, JAMA.

[10]  Andrew S Flett,et al.  Human non-contrast T1 values and correlation with histology in diffuse fibrosis , 2013, Heart.

[11]  M. Dweck,et al.  Calcific aortic stenosis: a disease of the valve and the myocardium. , 2012, Journal of the American College of Cardiology.

[12]  L. Mulligan,et al.  Left ventricular midwall fibrosis as a predictor of mortality and morbidity after cardiac resynchronization therapy in patients with nonischemic cardiomyopathy. , 2012, Journal of the American College of Cardiology.

[13]  O. Alfieri,et al.  Guidelines on the management of valvular heart disease (version 2012). , 2012, European heart journal.

[14]  A. Taylor,et al.  Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study. , 2012, European heart journal cardiovascular Imaging.

[15]  M. de Bonis,et al.  Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[16]  Peter Kellman,et al.  Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience , 2012, Journal of Cardiovascular Magnetic Resonance.

[17]  Kevin W Eliceiri,et al.  NIH Image to ImageJ: 25 years of image analysis , 2012, Nature Methods.

[18]  S. Priori,et al.  Late gadolinium enhancement by cardiovascular magnetic resonance is complementary to left ventricle ejection fraction in predicting prognosis of patients with stable coronary artery disease , 2012, Journal of Cardiovascular Magnetic Resonance.

[19]  P. Kellman,et al.  Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. , 2012, European heart journal.

[20]  C. Rihal,et al.  Current status of endomyocardial biopsy. , 2011, Mayo Clinic proceedings.

[21]  Pierre Croisille,et al.  Assessment of myocardial fibrosis with cardiovascular magnetic resonance. , 2011, Journal of the American College of Cardiology.

[22]  Y. Pinto,et al.  Molecular mechanisms that control interstitial fibrosis in the pressure-overloaded heart. , 2011, Cardiovascular research.

[23]  Gerrit A. Meijer,et al.  Rapid Quantification of Myocardial Fibrosis: A New Macro-Based Automated Analysis , 2010, Cellular Oncology.

[24]  Jeanette Schulz-Menger,et al.  An open-source software tool for the generation of relaxation time maps in magnetic resonance imaging , 2010, BMC Medical Imaging.

[25]  C. Rochitte,et al.  Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. , 2010, Journal of the American College of Cardiology.

[26]  M. Hayward,et al.  Equilibrium Contrast Cardiovascular Magnetic Resonance for the Measurement of Diffuse Myocardial Fibrosis: Preliminary Validation in Humans , 2010, Circulation.

[27]  M. Beer,et al.  Impact of Myocardial Fibrosis in Patients With Symptomatic Severe Aortic Stenosis , 2009, Circulation.

[28]  S. Plein,et al.  Myocardial T1 mapping: Application to patients with acute and chronic myocardial infarction , 2007, Magnetic resonance in medicine.

[29]  S. Donnelly,et al.  Diastolic Heart Failure: Evidence of Increased Myocardial Collagen Turnover Linked to Diastolic Dysfunction , 2007, Circulation.

[30]  David M Higgins,et al.  Human myocardium: single-breath-hold MR T1 mapping with high spatial resolution--reproducibility study. , 2006, Radiology.

[31]  P. Carmeliet,et al.  Increased Cardiac Expression of Tissue Inhibitor of Metalloproteinase-1 and Tissue Inhibitor of Metalloproteinase-2 Is Related to Cardiac Fibrosis and Dysfunction in the Chronic Pressure-Overloaded Human Heart , 2005, Circulation.

[32]  G. Nasso,et al.  Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate? , 2005, European heart journal.

[33]  David M Higgins,et al.  Modified Look‐Locker inversion recovery (MOLLI) for high‐resolution T1 mapping of the heart , 2004, Magnetic resonance in medicine.

[34]  G. Aurigemma,et al.  Diastolic heart failure , 2004, BMJ : British Medical Journal.

[35]  J. Schaper,et al.  Progression From Compensated Hypertrophy to Failure in the Pressure-Overloaded Human Heart: Structural Deterioration and Compensatory Mechanisms , 2003, Circulation.

[36]  Arantxa González,et al.  Losartan-Dependent Regression of Myocardial Fibrosis Is Associated With Reduction of Left Ventricular Chamber Stiffness in Hypertensive Patients , 2002, Circulation.

[37]  E. Herrold,et al.  Myocardial Fibrosis in Chronic Aortic Regurgitation: Molecular and Cellular Responses to Volume Overload , 2002, Circulation.

[38]  Arantxa González,et al.  Biochemical assessment of myocardial fibrosis in hypertensive heart disease. , 2001, Hypertension.

[39]  H. Mabuchi,et al.  Collagen remodeling and cardiac dysfunction in patients with hypertrophic cardiomyopathy: The significance of type III and VI collagens , 2001, Clinical cardiology.

[40]  O. Simonetti,et al.  The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. , 2000, The New England journal of medicine.

[41]  O H Bing,et al.  Matrix gene expression and decompensated heart failure: the aged SHR model. , 2000, Cardiovascular research.

[42]  R. Kloner,et al.  Quantitative assessment of myocardial collagen with picrosirius red staining and circularly polarized light , 1994, Basic Research in Cardiology.

[43]  O. Hess,et al.  Influence of collagen network on left ventricular systolic and diastolic function in aortic valve disease. , 1993, Journal of the American College of Cardiology.

[44]  O. Hess,et al.  Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. , 1989, Circulation.

[45]  M. Shimizu,et al.  Quantitation of myocardial fibrosis and its relation to function in essential hypertension and hypertrophic cardiomyopathy , 1988, Clinical cardiology.

[46]  O. Hess,et al.  Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement. , 1984, Circulation.