Native T1 Mapping for the Diagnosis of Myocardial Fibrosis in Patients With Chronic Myocardial Infarction
Issued Date
2022-12-01
Resource Type
ISSN
1936878X
eISSN
18767591
Scopus ID
2-s2.0-85142340851
Pubmed ID
36481075
Journal Title
JACC: Cardiovascular Imaging
Volume
15
Issue
12
Start Page
2069
End Page
2079
Rights Holder(s)
SCOPUS
Bibliographic Citation
JACC: Cardiovascular Imaging Vol.15 No.12 (2022) , 2069-2079
Suggested Citation
Kaolawanich Y., Azevedo C.F., Kim H.W., Jenista E.R., Wendell D.C., Chen E.l., Parker M.A., Judd R.M., Kim R.J. Native T1 Mapping for the Diagnosis of Myocardial Fibrosis in Patients With Chronic Myocardial Infarction. JACC: Cardiovascular Imaging Vol.15 No.12 (2022) , 2069-2079. 2079. doi:10.1016/j.jcmg.2022.09.011 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85226
Title
Native T1 Mapping for the Diagnosis of Myocardial Fibrosis in Patients With Chronic Myocardial Infarction
Author's Affiliation
Other Contributor(s)
Abstract
Background: Myocardial fibrosis is a fundamental process in cardiac injury. Cardiac magnetic resonance native T1 mapping has been proposed for diagnosing myocardial fibrosis without the need for gadolinium contrast. However, recent studies suggest that T1 measurements can be erroneous in the presence of intramyocardial fat. Objectives: The purpose of this study was to investigate whether the presence of fatty metaplasia affects the accuracy of native T1 maps for the diagnosis of myocardial replacement fibrosis in patients with chronic myocardial infarction (MI). Methods: Consecutive patients (n = 312) with documented chronic MI (>6 months old) and controls without MI (n = 50) were prospectively enrolled. Presence and size of regions with elevated native T1 and infarction were quantitatively determined (mean + 5SD) on modified look-locker inversion-recovery and delayed-enhancement images, respectively, at 3.0-T. The presence of fatty metaplasia was determined using an out-of-phase steady-state free-precession cine technique and further verified with standard fat-water Dixon methods. Results: Native T1 mapping detected chronic MI with markedly higher sensitivity in patients with fatty metaplasia than those without fatty metaplasia (85.6% vs 13.3%) with similar specificity (100% vs 98.9%). In patients with fatty metaplasia, the size of regions with elevated T1 significantly underestimated infarct size and there was a better correlation with fatty metaplasia size than infarct size (r = 0.76 vs r = 0.49). In patients without fatty metaplasia, most of the modest elevation in T1 appeared to be secondary to subchronic infarcts that were 6 to 12 months old; the T1 of infarcts >12 months old was not different from noninfarcted myocardium. Conclusions: Native T1 mapping is poor at detecting replacement fibrosis but may indirectly detect chronic MI if there is associated fatty metaplasia. Native T1 mapping for the diagnosis and characterization of myocardial fibrosis is unreliable.