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      Relationship between native papillary muscle T 1 time and severity of functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy

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          Abstract

          Background

          Functional mitral regurgitation is one of the severe complications of non-ischemic dilated cardiomyopathy (DCM). Non-contrast native T 1 mapping has emerged as a non-invasive method to evaluate myocardial fibrosis. We sought to evaluate the potential relationship between papillary muscle T 1 time and mitral regurgitation in DCM patients.

          Methods

          Forty DCM patients (55 ± 13 years) and 20 healthy adult control subjects (54 ± 13 years) were studied. Native T 1 mapping was performed using a slice interleaved T 1 mapping sequence (STONE) which enables acquisition of 5 slices in the short-axis plane within a 90 s free-breathing scan. We measured papillary muscle diameter, length and shortening. DCM patients were allocated into 2 groups based on the presence or absence of functional mitral regurgitation.

          Results

          Papillary muscle T 1 time was significantly elevated in DCM patients with mitral regurgitation ( n = 22) in comparison to those without mitral regurgitation ( n = 18) (anterior papillary muscle: 1127 ± 36 msec vs 1063 ± 16 msec, p < 0.05; posterior papillary muscle: 1124 ± 30 msec vs 1062 ± 19 msec, p < 0.05), but LV T 1 time was similar (1129 ± 38 msec vs 1134 ± 58 msec, p = 0.93). Multivariate linear regression analysis showed that papillary muscle native T 1 time (β = 0.10, 95 % CI: 0.05–0.17, p < 0.05) is significantly correlated with mitral regurgitant fraction. Elevated papillary muscle T 1 time was associated with larger diameter, longer length and decreased papillary muscle shortening (all p values <0.05).

          Conclusions

          In DCM, papillary muscle native T 1 time is significantly elevated and related to mitral regurgitant fraction.

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          Most cited references16

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          Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial.

          The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important.
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            Baseline correction of phase contrast images improves quantification of blood flow in the great vessels.

            Phase-contrast Cardiovascular Magnetic Resonance Imaging (CMR) generally requires the analysis of stationary tissue adjacent to a blood vessel to serve as a baseline reference for zero velocity. However, for the heart and great vessels, there is often no stationary tissue immediately adjacent to the vessel. Consequently, uncorrected velocity offsets may introduce substantial errors in flow quantification. The purpose of this study was to assess the magnitude of these flow errors and to validate a clinically applicable method for their correction. In 10 normal volunteers, phase-contrast CMR was used to quantify blood flow in the main pulmonary artery (Qp) and the aorta (Qs). Following image acquisition, phase contrast CMR was performed on a stationary phantom using identical acquisition parameters so as to provide a baseline reference for zero velocity. Aortic and pulmonary blood flow was then corrected using the offset values from the phantom. The mean difference between pulmonary and aortic flow was 26 +/- 21 mL before correction and 7.1 +/- 6.6 mL after correction (p = 0.002). The measured Qp/Qs was 1.25 +/- 0.20 before correction and 1.05 +/- 0.07 after correction (p = 0.001). Phase-contrast CMR can have substantial errors in great vessel flow quantification if there is no correction for velocity offset errors. The proposed method of correction is clinically applicable and provides a more accurate measurement of blood flow.
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              Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non-ischaemic dilated cardiomyopathy.

              Echocardiographic studies have shown that left atrial volume (LAV) predicts adverse outcome in small heart failure (HF) cohorts of mixed aetiology. However, the prognostic value of LAV in non-ischaemic dilated cardiomyopathy (DCM) is unknown. Cardiovascular magnetic resonance (CMR) allows accurate and reproducible measurement of LAV. We sought to determine the long-term prognostic significance of LAV assessed by CMR in DCM.
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                Author and article information

                Contributors
                skato1@bidmc.harvard.edu
                snakamor@bidmc.harvard.edu
                sebastien.roujol@kcl.ac.uk
                fdelling@bidmc.harvard.edu
                sakhtari@bidmc.harvard.edu
                jjang1@bidmc.harvard.edu
                tbasha@bidmc.harvard.edu
                sjberg@bidmc.harvard.edu
                kkissing@bidmc.harvard.edu
                bgoddu@bidmc.harvard.edu
                wmanning@bidmc.harvard.edu
                617-667-1747 , rnezafat@bidmc.harvard.edu
                Journal
                J Cardiovasc Magn Reson
                J Cardiovasc Magn Reson
                Journal of Cardiovascular Magnetic Resonance
                BioMed Central (London )
                1097-6647
                1532-429X
                16 November 2016
                16 November 2016
                2017
                : 18
                : 79
                Affiliations
                [1 ]Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
                [2 ]Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
                [3 ]Department of Cardiology, Yokohama City University Hospital, Yokohama, Japan
                [4 ]Biomedical Engineering Department, King’s College London, London, UK
                [5 ]Biomedical Engineering Department, Cairo University, Giza, Egypt
                Article
                301
                10.1186/s12968-016-0301-y
                5111188
                27846845
                2b79b87f-7ee5-43f9-9c45-1a4156c23490
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 July 2016
                : 29 October 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: 1R01HL129185
                Award ID: 1R21HL127650
                Award Recipient :
                Categories
                Research
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                © The Author(s) 2016

                Cardiovascular Medicine
                Cardiovascular Medicine

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