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Stress T1-mapping cardiovascular magnetic resonance imaging and inducible myocardial ischemia

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Abstract

Background

Alterations in native myocardial T1 under vasodilation stress (“T1 reactivity”) were recently proposed as a non-contrast cardiovascular magnetic resonance (CMR) method to detect myocardial ischemia. This study evaluated the performance of a segmental, truly non-contrast stress T1 mapping CMR approach to detect inducible ischemia.

Methods and results

One-hundred patients with suspected/known coronary artery disease underwent CMR at 3.0 or 1.5 T. T1 mapping was performed using the 5s(3s)3s-modified look-locker inversion-recovery (MOLLI) sequence at rest and under regadenoson stress. We defined T1 reactivity as the change in native T1 from rest to stress (1) in the 16-segment AHA model independent from perfusion images and (2) in focal regions of interest that were copied from perfusion images to T1 maps. We compared T1 reactivity between segments/regions with inducible ischemia, scar, and remote myocardium for both approaches. Segmental T1 reactivity was significantly lower in segments including inducible ischemia [− 1.15 (95% CI, − 2.16 to − 0.14)%] compared to remote segments [2.49 (95% CI, 1.87 to 3.11)%; p < 0.001]. Focal T1 reactivity was also significantly lower [− 2.65 (95% CI, − 3.84 to − 1.46)%] in regions with stress-perfusion defects compared to remote regions [4.72 (95% CI, 3.90 to 5.54)%; p < 0.001]. However, the performance of segmental T1 reactivity to depict inducible ischemia was significantly inferior compared to the focal approach (AUCs 0.68 versus 0.85; p < 0.0001).

Conclusions

Myocardium with inducible ischemia is characterized by the absence of significant T1 reactivity, but a clinically applicable approach for truly non-contrast stress T1 mapping remains to be determined.

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Authors and Affiliations

  1. General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany

    Sebastian Bohnen, Lennard Prüßner, Ulf K. Radunski, Jan Schneider, Ersin Cavus, Stefan Blankenberg & Kai Muellerleile

  2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    E. Vettorazzi

  3. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Enver Tahir, Maxim Avanesov, Gerhard Adam & Gunnar K. Lund

  4. Philips Research Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christian Stehning

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  1. Sebastian Bohnen
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  2. Lennard Prüßner
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Correspondence to Sebastian Bohnen.

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Dr. Stehning is an employee of Philips Research, Hamburg, Germany. The other authors report no conflicts.

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Bohnen, S., Prüßner, L., Vettorazzi, E. et al. Stress T1-mapping cardiovascular magnetic resonance imaging and inducible myocardial ischemia. Clin Res Cardiol 108, 909–920 (2019). https://doi.org/10.1007/s00392-019-01421-1

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