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Diffuse myocardial fibrosis in early forms of dilated cardiomyopathy: insights from T1 mapping cardiovascular magnetic resonance
© aus dem Siepen et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Cardiovascular Magnetic Resonance
- Dilate Cardiomyopathy
- Late Gadolinium Enhancement
- Myocardial Fibrosis
- Significant Coronary Artery Disease
The underlying myocardial injury in early forms of dilated cardiomyopathy (DCM) is unclear. Cardiovascular magnetic resonance (CMR) myocardial T1-mapping monitors the enlargement of the cardiac extra-cellular space and thus offers a non-invasive tool of quantitative measurement of myocardial fibrosis. We used T1-mapping techniques to explore the hypothesis that diffuse myocardial fibrosis is related to DCM.
We investigated 77 DCM patients (55 ± years, 51 males) and 46 healthy controls (52 ± years, 23 males). Significant coronary artery disease was excluded invasively. All CMR examinations were performed using 1.5 T CMR scanner (Philips Achieva). Short axis slices covering the LV were acquired using SSFP sequence to measure volumes and ejection fraction. T1-relaxation times were measured before and 15 minutes after Gd-DTPA (Magnograf) injection (0.2 mmol/kg). T1-maps were created out of 11 mid-ventricular short axis views with increasing inversion times (TI;100 - 4400 msec.) using a single breath-hold modified Look Locker inversion recovery sequence (MOLLI, TR/TE=3.5/1.8 msec, flip angle = 35°) in late diastole. Early DCM with mild reduction of LVEF was defined as EF between 45-55% while severely depressed LVEF was defined as EF<30%. Delta-T1 was calculated as non-contrast myocardial T1-post-contrast myocardial T1.
Diffuse myocardial fibrosis commences already at an early disease stage of DCM when LVEF is only mildly reduced. In contrast to focal fibrosis seen in LGE, diffuse fibrosis is more linked to the severity of LV dysfunction. Importantly, the differences between T1-values before and after contrast administration (delta-T1) appear to be a more reliable parameter in the assessment of myocardial fibrosis than a single time-point measurement.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.