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      Native T1 mapping: inter-study, inter-observer and inter-center reproducibility in hemodialysis patients

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          Abstract

          Background

          Native T1 mapping is a cardiovascular magnetic resonance (CMR) technique that associates with markers of fibrosis and strain in hemodialysis patients. The reproducibility of T1 mapping in hemodialysis patients, prone to changes in fluid status, is unknown. Accurate quantification of myocardial fibrosis in this population has prognostic potential.

          Methods

          Using 3 Tesla CMR, we report the results of 1) the inter-study, inter-observer and intra-observer reproducibility of native T1 mapping in 10 hemodialysis patients; 2) inter-study reproducibility of left ventricular (LV) structure and function in 10 hemodialysis patients; 3) the agreement of native T1 map and native T1 phantom analyses between two centres in 20 hemodialysis patients; 4) the effect of changes in markers of fluid status on native T1 values in 10 hemodialysis patients.

          Results

          Inter-study, inter-observer and intra-observer variability of native T1 mapping were excellent with co-efficients of variation (CoV) of 0.7, 0.3 and 0.4% respectively. Inter-study CoV for LV structure and function were: LV mass = 1%; ejection fraction = 1.1%; LV end-diastolic volume = 5.2%; LV end-systolic volume = 5.6%. Inter-centre variability of analysis techniques were excellent with CoV for basal and mid-native T1 slices between 0.8–1.2%. Phantom analyses showed comparable native T1 times between centres, despite different scanners and acquisition sequences (centre 1: 1192.7 ± 7.5 ms, centre 2: 1205.5 ± 5 ms). For the 10 patients who underwent inter-study testing, change in body weight (Δweight) between scans correlated with change in LV end-diastolic volume (ΔLVEDV) ( r = 0.682; P = 0.03) representing altered fluid status between scans. There were no correlations between change in native T1 between scans (ΔT1) and ΔLVEDV or Δweight ( P > 0.6). Linear regression confirmed ΔT1 was unaffected by ΔLVEDV or Δweight ( P > 0.59).

          Conclusions

          Myocardial native T1 is reproducible in HD patients and unaffected by changes in fluid status at the levels we observed. Native T1 mapping is a potential imaging biomarker for myocardial fibrosis in patients with end-stage renal disease.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12968-017-0337-7) contains supplementary material, which is available to authorized users.

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          Most cited references 45

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          Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study.

          Left ventricular (LV) hypertrophy (LVH) is a risk factor for mortality in patients with end-stage renal disease (ESRD). Whether the attenuation of LVH has a positive effect on survival of patients with ESRD has not been documented. The aim of this study was to determine the effect of parallel treatment of hypertension and anemia on LV mass (LVM) and to determine the effect of LVM changes on survival. A cohort of 153 patients receiving hemodialysis was studied. The duration of follow-up was 54 +/- 37 mo. All patients had echocardiographic determination of LV dimensions and LVM at baseline and regular intervals until the end of the follow-up period. During the study, BP decreased from (mean +/- SD) 169.4 +/- 29.7/90.2 +/- 15.6 to 146.7 +/- 29/78 +/- 14.1 mmHg (P < 0.001), and hemoglobin increased from 8.65 +/- 1.65 to 10.5 +/- 1.45 g/dl (P < 0.001). The LV end-diastolic diameter and mean wall thickness decreased from 56.6 +/- 6.5 to 54.8 +/- 6.5 mm (P < 0.001), and from 10.4 +/- 1.6 to 10.2 +/- 1.6 mm (P < 0.05), respectively. The LVM decreased from 290 +/- 80 to 264 +/- 86 g (P < 0.01). Fifty-eight deaths occurred, 38 attributed to cardiovascular (CV) disease and 20 attributed to non-CV causes. According to Cox analyses after adjustment for age, gender, diabetes, history of CV disease, and all nonspecific CV risk factors, LVM regression positively affected the survival. The hazard risk ratio associated with a 10% LVM decrease was 0.78 (95% confidence interval, 0.63 to 0.92) for all-causes mortality and 0.72 (95% confidence interval, 0.51 to 0.90) for mortality due to CV disease. These results show that a partial LVH regression in patients with ESRD had a favorable and independent effect on patients' all-cause and CV survival.
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            Surrogate markers for cardiovascular disease: structural markers.

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              Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart.

              A novel pulse sequence scheme is presented that allows the measurement and mapping of myocardial T1 in vivo on a 1.5 Tesla MR system within a single breath-hold. Two major modifications of conventional Look-Locker (LL) imaging are introduced: 1) selective data acquisition, and 2) merging of data from multiple LL experiments into one data set. Each modified LL inversion recovery (MOLLI) study consisted of three successive LL inversion recovery (IR) experiments with different inversion times. We acquired images in late diastole using a single-shot steady-state free-precession (SSFP) technique, combined with sensitivity encoding to achieve a data acquisition window of < 200 ms duration. We calculated T1 using signal intensities from regions of interest and pixel by pixel. T1 accuracy at different heart rates derived from simulated ECG signals was tested in phantoms. T1 estimates showed small systematic error for T1 values from 191 to 1196 ms. In vivo T1 mapping was performed in two healthy volunteers and in one patient with acute myocardial infarction before and after administration of Gd-DTPA. T1 values for myocardium and noncardiac structures were in good agreement with values available from the literature. The region of infarction was clearly visualized. MOLLI provides high-resolution T1 maps of human myocardium in native and post-contrast situations within a single breath-hold. Copyright 2004 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                +44 (0)116252 2522 , mpmgb1@le.ac.uk
                Journal
                J Cardiovasc Magn Reson
                J Cardiovasc Magn Reson
                Journal of Cardiovascular Magnetic Resonance
                BioMed Central (London )
                1097-6647
                1532-429X
                27 February 2017
                27 February 2017
                2017
                : 19
                Affiliations
                [1 ]ISNI 0000 0001 0435 9078, GRID grid.269014.8, John Walls Renal Unit, , University Hospitals Leicester NHS Trust, ; Leicester, UK
                [2 ]ISNI 0000 0004 1936 8411, GRID grid.9918.9, Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, , University of Leicester, ; Leicester, LE1 9HN UK
                [3 ]ISNI 0000 0004 1936 8542, GRID grid.6571.5, National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, , Loughborough University, ; Loughborough, UK
                [4 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, , University of Glasgow, ; 126 University Place, Glasgow, UK
                [5 ]ISNI 0000 0001 2177 007X, GRID grid.415490.d, The Glasgow Renal & Transplant Unit, , Queen Elizabeth University Hospital, ; 1345 Govan Road, Glasgow, UK
                [6 ]ISNI 0000 0004 1936 8411, GRID grid.9918.9, Department of Cardiovascular Sciences, , University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, ; Leicester, UK
                [7 ]ISNI 0000 0001 0523 9342, GRID grid.413301.4, , Clinical Physics, NHS Greater Glasgow and Clyde, ; Glasgow, UK
                [8 ]ISNI 0000 0004 0590 2070, GRID grid.413157.5, West of Scotland Heart and Lung Centre, , Golden Jubilee National Hospital, ; Clydebank, UK
                [9 ]ISNI 0000000121901201, GRID grid.83440.3b, UCL Institute of Cardiovascular Science, , University College London, ; London, UK
                Article
                337
                10.1186/s12968-017-0337-7
                5327541
                28238284
                © The Author(s). 2017

                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.

                Funding
                Funded by: National Institue for Health Research
                Award ID: CS-2013-13-014
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000291, Kidney Research UK;
                Categories
                Research
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                © The Author(s) 2017

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