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Correlation between native T1 and T2 mapping and MRI strain parameters in patients with myocarditis: a pilot study

Session Poster session 2

Speaker Matilda muca

Event : EuroCMR 2019

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

Authors : M Muca (Trieste,IT), L Pagnan (Trieste,IT), MG Belgrano (Trieste,IT), F Giudici (Trieste,IT), G Vitrella (Trieste,IT), G Sinagra (Trieste,IT), MA Cova (Trieste,IT)

M Muca1 , L Pagnan1 , MG Belgrano1 , F Giudici2 , G Vitrella3 , G Sinagra3 , MA Cova1 , 1Integrated University Hospital of Trieste (ASUITS), Radiology department - Trieste - Italy , 2Section of Biomedical Statistics, Department of Mathematics and Informatics, University of Trieste - Trieste - Italy , 3Integrated University Hospital of Trieste (ASUITS), Integrated cardiovascular activity department - Trieste - Italy ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii364


During myocarditis, an increase in myocardial free water content due to inflammation and oedema occur, with a lengthening of T1 and T2 relaxation times. Myocardial strain can characterize ventricular dysfunction in patients with conserved ejection fraction and the left ventricle global systolic longitudinal strain have been reported to be a predictor of full functional recovery upon follow-up in patients with acute myocarditis. 


The aim of this study was to observe if there is a correlation between T1 and T2 mapping and feature tracking parameters in cases of myocarditis and to compare T1 and T2 mapping values between patients with myocarditis and those considered at low-risk for any kind of cardiomyopathy.


In this retrospective study 28 Patients (19 with myocarditis and 9 at low-risk of cardiomyopathy) were enrolled from November 2017 to October 2018. All patients underwent standard cardiac magnetic resonance (CMR) and T1 and T2 mapping sequences. Mapping and strain parameter evaluation were performed with two dedicated software.


Native T1 mapping values for basal slice were significantly increased (p=0.03) in patients with diagnosis of myocarditis compared to low-risk patients. T2 mapping values for basal and apical slice were increased in patients with myocarditis compared with low-risk patients, with statistically significant differences between two groups (p value respectively of 0.04 and 0.05). Apositive and significant correlation (p=0.02) between increased values of T1 mapping for medium slice and decreased peak longitudinal strain in patients with myocarditis was observed. Furthermore, still for the medium slice in patients with myocarditis, a positive correlation between increased native T1 mapping values and decreased values of peak circumferential strain (p=0.01), peak short axis radial strain (p = 0.009) and peak long axis radial strain (p=0.02) was observed.
We know from previous studies that changes of myocardial tissue composition lead to alterations of T1 and T2 relaxation time and mapping techniques can quantify tissue alterations. Native T1 mapping can reliably discriminate between low-risk patients and those with myocarditis, and may emerge as a novel approach to monitor inflammatory myocardial injuries as a dynamic index of disease activity and progression.
As a novel result of the current study, patients with myocarditis manifest a correlation between altered values of T1 mapping and strain parameters as a demonstration of underlying relevant structural alteration that can lead to important cardiac dysfunction.


Our study suggests the utility of systematic use of T1 and T2 mapping sequences and feature tracking analysis in CMR as an integral part of the diagnosis and management of myocarditis, identifying potentially high-risk patients with latent ventricular dysfunction.

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