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Detection of myocardial fibrosis in asymptomatic patients on renal replacement therapy

Session Poster session 2

Speaker Arunachalam Pudhiavan

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : T1 and T2 Mapping, T2*
  • Session type : Poster Session

Authors : A Pudhiavan (Bangalore,IN), VIMAL Raj (Bangalore,IN), RICHA Kothari (Bangalore,IN), R Sripad Bhat (Bangalore,IN), K V Shrikanth (Bangalore,IN), MD Moinuddin Nawazi (Bangalore,IN)

A Pudhiavan1 , VIMAL Raj1 , RICHA Kothari1 , R Sripad Bhat2 , K V Shrikanth2 , MD Moinuddin Nawazi2 , 1Narayana Institute of cardiac sciences, Cardiac Radiology - Bangalore - India , 2Narayana Institute of cardiac sciences - Bangalore - India ,

T1 and T2 Mapping, T2*

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii360

Introduction: Myocardial fibrosis has traditionally been detected and quantified with delayed enhancement imaging with the use of gadolinium chelate contrast agents. In CKD patients, this is contraindicated due to its association with nephrogenic systemic fibrosis. Cardiac magnetic resonance (CMR) native T1 mapping is a novel technique for detection of myocardial fibrosis without the need for intravenous contrast agents.

Purpose: To determine the value of CMR native T1 mapping in identifying the myocardial fibrosis in patients undergoing renal replacement therapy without use of gadolinium chelates.

Methods: The study included 74 patients with chronic kidney disease undergoing hemodialysis. A non contrast CMR examination was done using a 3 T MR system. Native T1 mapping was done using a modified look locker inversion recovery (MOLLI) sequence. T1 values are calculated by drawing mid ventricular contours along left ventricle (LV) myocardium.

Results: The study participants had an average age of 54±12 years with 54 males and 20 females. The native T1 values in the study population was significantly increased compared to healthy controls (p < 0.001). 29 males and 5 females had an elevated native T1 value with an average T1 value of 1330±27 ms for males and 1375±17 ms for females. Among the study population, 35 were diabetics and 70 werehypertensive. Native T1 values in the study population had no correlation with diabetes mellitus and hypertension (p of 0.3 and 0.2 respectively). Dialysis vintage and the frequency of hemodialysis had no correlation with the native T1 values (p of 0.1 and 0.3 respectively).

Conclusion: Native T1 values are significantly elevated in chronic kidney disease patients on renal replacement therapy. The native T1 values had no statistically significant correlation with dialysis vintage, frequency of dialysis, diabetes and hypertensive status of the patients. This is likely to the development of myocardial fibrosis due to cardiomyopathy specific to uremia.

Number of patients 54 20
Age 54.6±12 years 52.5±11 years
Dialysis vintage/ frequency 3.1±2 years/ 2.8 times per week 3.5±2 years/ 2.9 times per week
DM/ HT 24/ 51 11/ 19
Control native T1 value 1250±50 ms 1300±50 ms
Patients with raised native T1 29 5
Mean abnormal native T1 value 1330±27 ms 1375±17 ms
DM - Diabetes mellitus, HT - Hypertension.

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