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Role of native T1 mapping in assessment of patients post correction of tetralogy of Fallot

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), GA Karthik (Bangalore,IN), RICHA Kothari (Bangalore,IN), DEVI Prasad Shetty (Bangalore,IN), S Shankar Maiya (Bangalore,IN), P V Suresh (Bangalore,IN)

Authors:
A Pudhiavan1 , VIMAL Raj1 , GA Karthik1 , RICHA Kothari1 , DEVI Prasad Shetty2 , S Shankar Maiya2 , P V Suresh2 , 1Narayana Institute of cardiac sciences, Cardiac Radiology - Bangalore - India , 2Narayana Institute of cardiac sciences - Bangalore - India ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii362

Introduction: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease and more patients survive into adulthood post correction. Cardiac magnetic resonance (CMR) provides accurate ventricular size, function and valvular regurgitation during post surgical follow up. This helps in planning for further surgical interventions and prognosis. Native T1 mapping is a predictor of myocardial fibrosis and has the potential to be a prognostic indicator in these patients.

Purpose: To assess the native T1 values in patients post correction of TOF and examine its relation to various prognostic indicators.

Methods: Fifty three consecutive TOF patients underwent CMR on a 3T system. Native T1 mapping was done using a modified look locker inversion recovery (MOLLI) sequence. T1 values were calculated by drawing region of interest in the septum, left ventricle (LV) and right ventricle (RV) free wall.

Results: The study participants had an average age of 16±8 years with 33 males and 20 females. The indexed RV end diastolic volumes (iRVEDV) were raised, with males having a higher mean volume than females. Males had more pulmonary regurgitation (PR) compared to females, with a combined mean PR fraction of 43±15%. The native T1 values of the LV were within normal limits in all patients. Native T1 values of RV free wall were significantly raised, measuring 1312±65 ms in males (p < 0.001) and 1385±92 ms in females (p < 0.001). The RV T1 values increased with increasing iRVEDV (p <0.01). The RV T1 values had no correlation with RV ejection fraction (p value 0.12) and PR (p value 0.25).

Conclusion: Patients post correction of TOF demonstrate raised native T1 values of the RV.  The iRVEDV, RV ejection fraction and PR fraction are known prognostic indicators in post TOF correction patients. In our study, RV native T1 values were independent of the RV ejection fraction, PR fraction and LV T1 values and had a statistically significant correlation with increasing iRVEDV. Native T1 values of RV myocardium has a prognostic value along with the other traditional prognostic factors in post correction of TOF patients.

MALE FEMALE MALE FEMALE
Number of patients/ Age 33/ 17.6±9 years 20/ 14.4±7 years RV ejection fraction 50±10% 52±8%
iRVEDV 163±50 ml/sq.m 133±49 ml/sq.m LV ejection fraction 52±13% 56±8%
iLVEDV 93±46 ml/sq.m 68±39 ml/sq.m RV native T1 value 1312±65 ms 1385±92 ms
Pulmonary regurgitation 45±14% 40±15% LV native T1 value 1260±60 ms 1284±67 ms
iRVEDV – indexed right ventricular end diastolic volume, iLVEDV – indexed left ventricular end diastolic volume

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