CORRELATION BETWEEN LEFT VENTRICULAR CONTRACTILITY AND MYOCARDIAL T1-RELAXATION TIME DURING MAPPING IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BY MAGNETIC RESONANCE IMAGING

Objective. To determine a correlation of myocardial deformation with myocardial T1-relaxation time during extracellular volume (ECV) fraction mapping and the degree of focal fibrosis in each left ventricular (LV) segment in patients with hypertrophic cardiomyopathy (HCM).

Material and methods. A diagnostic test was carried out in 30 patients diagnosed with HCM and in a control group of 10 patients without LV pathology. Cardiac magnetic resonance imaging was performed on a 3.0 T Philips Achieva TX MRI scanner (Philips, Best, the Netherlands) in accordance of the specialized protocol using a 32-channel cardiac coil with heart rate synchronization and the use of gadolinium-based contrast agents at a dose of 0.3 ml/kg. LV T1 mapping was done using the Modified Look-Locker Inversion Recovery (MOLLI) sequences. Postprocessing was performed on Philips and CVI42 workstations. When the data were processed, T1-relaxation time was estimated before and after contrast enhancement.

Results. In all cases, myocardial thickness, extent of myocardial fibrosis, myocardial T1-relaxation time parameters, and ECV could be estimated according to the American Heart Association 16-segment coronary artery model. Before injection of contrast agent, the average LV T1 relaxation time in patients with HCM was 1317±94 msec which was significantly higher than that in the control group (1093±23.7 msec). ECV in the control group was lower (24.8±1.9%) than that in the HCM group (29.8±4.5%). In the univariable group, each index was related to myocardial deformation indicators (radial (Err-FT) and circular (Ecc-FT)) at the segment level. There was a moderate positive correlation between LV thickness and Ecc-FT (r=0.52; p<0.0001), a moderate negative correlation between Err-FT and LV hypertrophy (r=–0.5; p<0.0001), and between Err-FT and myocardial T1relaxation time prior to contrast enhancement (r=–0.5; p<0.0001).

Conclusion. Myocardial T1 time relaxation mapping before contrast enhancement has detected that ECV in patients with HCM is much higher than in those with the intact myocardium. LV deformation in patients with HCM correlates with changes in myocardial T1 time and the magnitude of myocardial hypertrophy and to a lesser extent with focal LV fibrosis. 

1. Hansen M.W., Merchant N. MRI of hypertrophic cardiomyopathy. Part I, MRI appearances. Am. J. Roentgenol. 2007; 189: 1335–43.

2. Чудиновских Ю.А., Еремеева М.В., Сухачева Т.В. Особенности морфологии и механизма патогенеза гипертрофической кардиомиопатии. Кардиология. 2011; 51 (2): 81–8. [Chudinovskikh Yu.А., Eremeeva M.V., Sukhacheva T.V. Peculiarities of morphology and mechanisms of pathogenesis of hypertrophic cardiomyopathy. Kardiologiia. 2011; 51 (2): 81–8 (in Russ.).]

3. Синицын В.Е., Мершина Е.А., Першина Е.С., Благова О.В. Редкий случай некоронарогенного ишемического поражения миокарда при гипертрофической кардиомиопатии. Лучевая диагностика и терапия. 2014; 3-1: 16–8. [Sinitsyn V.E., Mershina E.A., Pershina E.S., Blagova O.V. A rare case of ischemic myocardial damage in hypertrophic cardiomyopathy. Diagnostic Rradiology and Radiotherapy. 2014; 3-1: 16–8 (in Russ.).]

4. Ellims A.H., Iles L.M., Hare J.L., Kaye D.M., Taylor A.J. A comprehensive evaluation of myocardial fibrosis in hypertrophic cardiomyopathy with cardiac magnetic-resonance imaging: link in genotype with fibrotic phenotype. J. Cardiovasc. Magn. Res. 2012; 14: 76.

5. Бокерия О.Л., Шадания Я.Р., Аверина И.И., Мироненко М.Ю., Донцова В.И., Соболева Н.Н. Использование показателей деформации миокарда при отборе пациентов на сердечную ресинхронизирующую терапию. Анналы аритмологии. 2011; 8 (1): 30–4. [Bockeria O.L., Shadaniya Ya.R., Averina I.I., Mironenko M.Yu., Dontsova V.I., Soboleva N.N. The usage of indices of myocardium deformation in the selection of patients for cardiac resynchronized therapy. Annaly Aritmologii. 2011; 8(1): 30–4 (in Russ.).]

6. Moody W.E., Taylor R.J., Edwards N.C., Chue C.D., Umar F., Taylor T.J. et al. Comparison of magnetic resonance feature tracking for systolic and diastolic strain rate calculation with spatial modulation of magnetization imaging analysis. J. Magn. Reson. Imaging. 2015; 41: 1000–12.

7. Cerqueira M.D., Weissman N.J., Dilsizian V., Jacobs A.K., Kaul S., Laskey W.K. et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A Statement for Healthcare Professionals From the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002; 105: 539–42.

8. Donekal S., Ambale-Venkatesh B., Berkowitz S., Wu C., Choi E.Y., Fernandes V. Inter-study reproducibility of cardiovascular magnetic resonance tagging. J. Cardiovasc. Magn. Reson. 2013; 15: 37.

9. Flett A.S., Hayward M.P., Ashworth M.T., Hansen M.S., Taylor A.M., Elliott P.M. et al. Equi librium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010; 122: 138–44.

10. Schelbert E.B., Messroghli D.R. State of the art: сlinical applications of cardiac T1 mapping. Radiology. 2016; 278: 658–76.

11. Miller C.A., Naish J.H., Bishop P., Coutts G., Clark D., Zhao S. et al. Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ. Cardiovasc. Imaging. 2013; 6: 373–83.

12. Watkins H., Ashrafian H., McKenna W.J. The genetics of hypertrophic cardiomyopathy: Teare redux. Heart. 2008; 94 (10): 1264–8.

13. Перуцкий Д.Н., Макеева Т.И., Константинов С.Л. Возможности стресс-эхокардиографии в диагностике жизнеспособного миокарда у больных ишемической болезнью сердца. Рациональная фармакотерапия в кардиологии. 2011; 7 (3): 334–41. [PerutskiyD.N., Makeeva T.I., Konstantinov S.L. Value of stress echocardiography in diagnosis of viable myocardium in patients with ischemic heart disease. Rational Pharmacotherapy in Cardiology. 2011; 7 (3): 334–42 (in Russ.).]

14. Smith B.M., Dorfman A.L., Yu S., Russell M.W., Agarwal P.P., Mahani M.G. et al. Clinical significance of late gadolinium enhancement in patients < 20 years of age with hypertrophic cardiomyopathy. Am. J. Cardiol. 2014; 113: 1234–9.

15. Kellman P., Arai A.E., Xue H. T1 and extracellular volume mapping in the heart: estimation of error maps and the influence of noise on precision. J. Cardiovasc. Magn. Reson. 2013; 15: 56.