Advertisement

Native T1 mapping to detect extent of acute and chronic myocardial infarction: comparison with late gadolinium enhancement technique

  • Amardeep Ghosh Dastidar
  • Iwan Harries
  • Giulia Pontecorboli
  • Vito D. Bruno
  • Estefania De Garate
  • Charlie Moret
  • Anna Baritussio
  • Thomas W. Johnson
  • Elisa McAlindon
  • Chiara Bucciarelli-DucciEmail author
Original Paper

Abstract

Investigate whether native-T1 mapping can assess the transmural extent of myocardial infarction (TEI) thereby differentiating viable from non-viable myocardium without the use of gadolinium-contrast in both acute and chronic myocardial infarction (aMI and cMI). Sixty patients (30 cMI > 1 year and 30 aMI day 2 STEMI) and 20 healthy-controls underwent 1.5 T CMR to assess left ventricular function (cine), native-T1 mapping (MOLLI sequence 5(3)3, motion-corrected) and the presence and TEI from late gadolinium enhancement (LGE) images. Segments with TEI > 75% was considered non-viable. Gold-standard LGE-TEI was compared with corresponding segmental native-T1. Segmental native-T1 correlated significantly with TEI (R = 0.74, p < 0.001 in cMI and R = 0.57, p < 0.001 in aMI). Native-T1 differentiated segments with no LGE (1031 ± 31 ms), LGE positive but viable (1103 ± 57 ms) and LGE positive but non-viable (1206 ± 118 ms) in cMI (p < 0.01). It also differentiated segments with no LGE (1054 ± 65 m), LGE positive but viable (1135 ± 73 ms) and LGE positive but non-viable (1168 ± 71 ms) in aMI (p < 0.01). ROC analysis demonstrated excellent accuracy of native-T1 mapping compared to LGE-TEI (AUC − 0.88, p < 0.001 in cMI, vs AUC − 0.83, p < 0.001 in aMI). Native-T1 performed better in cMI than aMI (p < 0.01). In cMI a segmental T1 threshold of 1085 ms differentiated viable from non-viable segments with a sensitivity 88% and specificity of 88% whereas a T1 of 1110 ms differentiated viable from nonviable with 79% sensitivity and 79% specificity in aMI. Native-T1 mapping correlates significantly with TEI thereby differentiating between normal, viable, and non-viable myocardium with distinctive T1 profiles in aMI and cMI. Native T1-mapping to detect MI performed better in cMI compared to aMI due to absence of myocardial oedema. Native-T1 mapping holds promise for viability assessment without the need for gadolinium-contrast agent.

Keywords

Viability T1 mapping Cardiovascular magnetic resonance Myocardial infarction 

Abbreviations

CMR

Cardiovascular magnetic resonance

LGE

Late gadolinium enhancement

TEI

Transmural extent of infarct

AHA

American Heart Association

LV

Left ventricular

MI

Myocardial infarction

STEMI

ST-elevation myocardial infarction

MVO

Microvascular obstruction

AUC

Area under curve

ROC

Receiver operating characteristic

Notes

Acknowledgements

We thank Mr Christopher Lawton, superintendent radiographer, and his team of specialist CMR radiographers from the Bristol Heart Institute for their expertise in performing the CMR studies.

Authors’ contributions

AGD and CBD conceived the study design. EM & CBD coordinated and performed the MOIST trial. AGD, GP, VDB, IH, EDG, CM and IE participated in the analysis of CMR. AGD, IH, GP and CBD helped to interpret the data and draft the manuscript. All authors read and approved the final manuscript.

Funding

Dr Chiara Bucciarelli-Ducci is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. AGD is funded by the David Telling Charitable Trust.

Compliance with ethical standards

Conflict of interest

Dr Chiara Bucciarelli-Ducci is a consultant for CircleCVI. The other authors of the manuscript declare no conflict of interest.

References

  1. 1.
    Romero J, Xue X, Gonzalez W, Garcia MJ (2012) CMR imaging assessing viability in patients with chronic ventricular dysfunction due to coronary artery disease: a meta-analysis of prospective trials. JACC Cardiovasc Imaging 5(5):494–508CrossRefGoogle Scholar
  2. 2.
    Dastidar AG, Rodrigues JCL, Baritussio A, Bucciarelli-Ducci C (2016) MRI in the assessment of ischaemic heart disease. Heart 102(3):165–167CrossRefGoogle Scholar
  3. 3.
    Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O et al (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343(20):1445–1453CrossRefGoogle Scholar
  4. 4.
    Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O et al. (1999) Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 100(19):1992–2002CrossRefGoogle Scholar
  5. 5.
    Layne KA, Dargan PI, Archer JRH, Wood DM (2018) Gadolinium deposition and the potential for toxicological sequelae - A literature review of issues surrounding gadolinium-based contrast agents. Br J Clin Pharmacol. http://www.ncbi.nlm.nih.gov/pubmed/30032482. Accessed 25 Sept 2018
  6. 6.
    Kanal E, Tweedle MF (2015) Residual or retained gadolinium: practical implications for radiologists and our patients. Radiology 275(3):630–634CrossRefGoogle Scholar
  7. 7.
    Bulluck H, Maestrini V, Rosmini S, Abdel-Gadir A, Treibel TA, Castelletti S et al (2015) Myocardial T1 mapping. Circ J 79(3):487–494CrossRefGoogle Scholar
  8. 8.
    Kali A, Choi EY, Sharif B, Kim YJ, Bi X, Spottiswoode B et al (2015) Native T1 Mapping by 3-T CMR imaging for characterization of chronic myocardial infarctions. JACC Cardiovasc Imaging 8(9):1019–1030CrossRefGoogle Scholar
  9. 9.
    Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–619Google Scholar
  10. 10.
    Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al (2012) Third universal definition of myocardial infarction. Eur Heart J 33:2551–2567CrossRefGoogle Scholar
  11. 11.
    McAlindon EJ, Pufulete M, Harris JM, Lawton CB, Moon JC, Manghat N et al. Measurement of myocardium at risk with cardiovascular MR: comparison of techniques for edema Imaging. Radiol 275(1):61–70Google Scholar
  12. 12.
    McAlindon E, Pufulete M, Lawton C, Angelini GD, Bucciarelli-Ducci C (2015) Quantification of infarct size and myocardium at risk: evaluation of different techniques and its implications. Eur Heart J Cardiovasc Imaging 16(7):738–746CrossRefGoogle Scholar
  13. 13.
    Rodrigues JCL, Amadu AM, Dastidar AG, Szantho GV, Lyen SM, Godsave C et al (2016) Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes. Heart. http://www.ncbi.nlm.nih.gov/pubmed/27260191. Accessed 20 Sept 2016
  14. 14.
    Simonetti OP, Finn JP, White RD, Laub G, Henry DA (1996) “Black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology 199(1):49–57CrossRefGoogle Scholar
  15. 15.
    Karamitsos TD, Hudsmith LE, Selvanayagam JB, Neubauer S, Francis JM (2007) Operator induced variability in left ventricular measurements with cardiovascular magnetic resonance is improved after training. J Cardiovasc Magn Reson 9(5):777–783CrossRefGoogle Scholar
  16. 16.
    Bulluck H, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M et al (2017) Redefining viability by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction. Sci Rep 7(1):14676CrossRefGoogle Scholar
  17. 17.
    Pica S, Sado DM, Maestrini V, Fontana M, White SK, Treibel T et al (2014) Reproducibility of native myocardial T1 mapping in the assessment of Fabry disease and its role in early detection of cardiac involvement by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 16:99CrossRefGoogle Scholar
  18. 18.
    Carrick D, Haig C, Rauhalammi S, Ahmed N, Mordi I, McEntegart M et al (2015) Pathophysiology of LV remodeling in survivors of STEMI: inflammation, remote myocardium, and prognosis. JACC Cardiovasc Imaging 8(7):779–789CrossRefGoogle Scholar
  19. 19.
    Bucciarelli-Ducci C, Auger D, Di Mario C, Locca D, Petryka J, O’Hanlon R et al (2016) CMR Guidance for recanalization of coronary chronic total occlusion. JACC Cardiovasc Imaging [9(5):547–556CrossRefGoogle Scholar
  20. 20.
    Ferreira VM, Piechnik SK, Dall’Armellina E, Karamitsos TD, Francis JM, Ntusi N et al (2014) Native T1-mapping detects the location, extent and patterns of acute myocarditis without the need for gadolinium contrast agents. J Cardiovasc Magn Reson 16(1):36CrossRefGoogle Scholar
  21. 21.
    Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 39(2):119–77Google Scholar
  22. 22.
    Schwitter J, Saeed M, Wendland MF, Derugin N, Canet E, Brasch RC et al (1997) Influence of severity of myocardial injury on distribution of macromolecules: extravascular versus intravascular gadolinium-based magnetic resonance contrast agents. J Am Coll Cardiol 30(4):1086–1094CrossRefGoogle Scholar
  23. 23.
    Beek AM, Kühl HP, Bondarenko O, Twisk JWR, Hofman MBM, van Dockum WG et al (2003) Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. J Am Coll Cardiol 42(5):895–901CrossRefGoogle Scholar
  24. 24.
    Heidary S, Patel H, Chung J, Yokota H, Gupta SN, Bennett MV et al (2010) Quantitative tissue characterization of infarct core and border zone in patients with ischemic cardiomyopathy by magnetic resonance is associated with future cardiovascular events. J Am Coll Cardiol 55(24):2762–2768CrossRefGoogle Scholar
  25. 25.
    Dall’Armellina E, Ferreira VM, Kharbanda RK, Prendergast B, Piechnik SK, Robson MD et al (2013) Diagnostic value of pre-contrast T1 mapping in acute and chronic myocardial infarction [Internet]. JACC Cardiovascular Imaging 6:739–742CrossRefGoogle Scholar
  26. 26.
    Dall’Armellina E, Piechnik SK, Ferreira VM, Le Si Q, Robson MD, Francis JM et al (2012) Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction. J Cardiovasc Magn Reson 14:15CrossRefGoogle Scholar
  27. 27.
    Bulluck H, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M et al (2017) Diagnostic performance of T1 and T2 mapping to detect intramyocardial hemorrhage in reperfused ST-segment elevation myocardial infarction (STEMI) patients. J Magn Reson Imaging 46(3):877–886CrossRefGoogle Scholar
  28. 28.
    Bulluck H, White SK, Rosmini S, Bhuva A, Treibel TA, Fontana M et al (2017) T1 mapping and T2 mapping at 3T for quantifying the area-at-risk in reperfused STEMI patients. J Cardiovasc Magn Reson 17:73CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Amardeep Ghosh Dastidar
    • 1
    • 3
  • Iwan Harries
    • 1
    • 3
  • Giulia Pontecorboli
    • 1
  • Vito D. Bruno
    • 1
    • 3
  • Estefania De Garate
    • 1
    • 2
    • 3
  • Charlie Moret
    • 1
  • Anna Baritussio
    • 1
  • Thomas W. Johnson
    • 1
  • Elisa McAlindon
    • 1
    • 2
  • Chiara Bucciarelli-Ducci
    • 1
    • 2
    • 3
    Email author
  1. 1.Bristol Heart InstituteUniversity Hospitals Bristol NHS TrustBristolUK
  2. 2.NIHR Bristol Cardiovascular Biomedical Research Centre, Bristol Heart InstituteUniversity Hospitals Bristol and University of BristolBristolUK
  3. 3.Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK

Personalised recommendations