| Background:Left ventricular non-compaction (LVNC) is a cardiomyopathy characterized by prominent trabeculations and deep intertrabecular recesses in the left ventricle. The typical characteristic of the myocardium is divided into two layers, one is abnormal increase of trabecular forming a non-compacted layer, and the other one is thin layer of compaction. At present, echocardiogram was usually used to diagnose LVNC, but it had some weakness in identifying myocardial tissue and the influence by acoustic window and the experience of operators. However, Cardiovascular Magnetic resonance imaging (CMR) can clearly dynamically show the course of the myocardial systolic and diastolic function in each cardiac circle and evaluate myocardial tissue morphology characteristics with high resolution. Therefore CMR was used to evaluate the tissue and functional characteristics of LVNC.Aims:To investigate LVNC morphologic characteristics and the relationship between non-compaction segments and left ventricular systolic function by CMR.Materials and Methods:Patients with LVNC were diagnosed by two senior cardiologists according to the Jenny echocardiography criteria.31 LVNC patients including in 17 males (mean age 42.1±15.2 years), and 14 matched age and gender for the normal volunteers were scanned by 3.0 T MR system using a 32-channel phased array heart coil. The CINE image sequences were acquired. The images were analyzed by MATLAB according to AHA standard segments. Patients were grouped into patients with preserved left ventricular ejection fraction (LVPEF), and patients with reduced left ventricular ejection fraction (LVREF).Results:There were 227 non-compaction segments in the 31 LVNC patients. In addition, the lateral wall had the most non-compaction segments (95), while the interventricular septum had the least (22), and mainly located near apex. The mass index of left ventricular compaction layers of normal controls, patients with high LVEF and low LVEF were 47.6 ± 5.5g/m2,41.7±7.6g/m2 and 60.8±22.2g/m2, respectively. ANOVA showed a significant difference in mass among the 3 groups (F=9.54, p<0.001). The post-hoc with Bonferroni analysis showed that LVREF patients had high left ventricular mass of compaction than that of normal controls (p=0.016) and LVPEF patients (p<0.001), but no difference was found between normal controls and LVPEF patients (p=0.10). There were no significant correlations between the LVEFs and non-compaction segments and NC/C with LVEF in LVNC patients (r=0.05, p=0.79; r= 0.1, P=0.14).Conclusion:1. CMR can clearly show the non-compaction and compaction morphologic characteristics2. Non-compaction segments were most likely located in the left lateral wall, and least in the interventricular septum3. The mass of compaction does not discrease in the LVPEF group, and increases in the LVREF group.4. There were no correlations among the LVEFs and non-compaction segments and the ratio of NC/C in LVNC patients.Background:Left ventricular non-compaction (LVNC) is a abnormally developmental cardiomyopathy characterized by prominent trabeculations and deep intertrabecular recesses in the left ventricle. The typical characteristic of the myocardium is divided into two layers, one is abnormal increase of trabecular forming a non-compacted layer, and the other one is thin compacted layer. In recent years, some CMR with the Late Gadolinium Enhancement, LGE) studies have found that thinning compacted myocardium always have fibrosis, but the relationships between the fibrosis of the position and degree of involvement of LVNC disease segments and clinical adverse events were unknown.Aims:To investigate the relations between the fibrosis of the position and degree of involvement of compacted myocardium and left ventricular ejection fraction (LVEF) in LVNC patients.Materials and Methods:Patients with LVNC were diagnosed by two senior cardiologists according to the Jenny echocardiography criteria.31 LVNC patients including in 17 males,and 8 matched age and gender for the normal volunteers were scanned by 3.0 T MR system using a 32-channel phased array heart coil. The Phase-sensitive Inversion Recovery (PSIR) image sequences were acquired after injected Gd-DTPA (0.2 mmol/kg,2 ml/s) for about 10 minutes. The images were analyzed by MATLAB according to AHA standard segments. Patients were grouped into patients with (LGE(+)) and without LGE (LGE(-)) groups.Results:Of all 31 LVNC patients,14 (45%) had LGE in the myocardium in 96 (40%) compacted segments. The LGE lesions were found to most likely involve in the basal anteroseptal segments, followed by apical anterior and basal inferoseptal segments, left ventricular mass of compaction index (LVMCI) of normal controls, LGE(-) and LGE(+) patients were 47.2 ± 5.2 g/m2,45.5 ± 12.8 g/m2 and 63.1 ± 27.6 g/m2, respectively. ANOVA showed significant differences among the 3 groups (F=3.7, P=0.03). The post hoc with SNK showed that LVNC patients with LGE had higher LVMCI than that of LVNC patients without LGE and normal controls, but no difference was found in LVNC patients without LGE and normal controls. The non-compaction segments of LGE(+) and LGE(-) groups were 110 and 107 respectively, and LGE(+) group had more non-compaction segments than that of LGE(-) group (p=0.041). In addition, the number of segments with LGE is negative related to LVEFs (R=-0.57, p< 0.01).Conclusion:CMR-LGE can be non-invasive and in vivo assessment of myocardial fibrosis in patients with LVNC involvement degree and the scope. The LGE lesions were found to most likely involve in the basal anteroseptal segments, followed by apical anterior and basal inferoseptal segments. The number of segments with LGE is negative related to LVEFs. The LGE(+) patients has higher LVMCI and more non-compaction segments.Background:Native T1 mapping is an emerging cardiac magnetic resonance technique for quantitative and early evaluation of cardiomyopathies abnormality, especially for diffused myocardial fibrosis. At present, it has been widely used to study for cardiomyopathies. Histopathology has shown that myocardial T1 values in patients with diffuse myocardial fibrosis correlate well with fibrosis confirmed by myocardial biopsy. But there is a blank in LVNC between compacted layer native T1 and LVEFs.Aims:To investigate the relationships between compacted layer native T1 and LVEFs in LVNC patients using native T1 mapping.Materials and Methods:31 LVNC patients including 9 family history members and 14 matched age and gender for the normal volunteers were scanned by 3.0 T MR system using a 32-channel phased array heart coil. Cine and MOLLI sequences were performed with four chamber view, two chamber view, long and short axis view of left ventricle to acquire Cine images and native T1 maps. All the data were analyzed by MATLAB according to AHA standard segments. Patients were grouped into patients with preserved left ventricular ejection fraction (LVPEF), and patients with reduced left ventricular ejection fraction (LVREF).Results:The mean native T1 value of normal controls, LVPEF and LVREF patients was 1096.0±41.5ms,1134.4±42.1ms,1174.0±47.1ms, respectively. Significant differences were found in native T1 among the 3 groups, (F=13.8, p<0.001), and the post-hoc with SNK showed significant differences between any two groups. Furthmore, LVREF patients had the highest native Tl value, followed by LVPEF patients, and normal controls. In addition, the mean native T1 of patients with family history members is significantly higher than that of non-family history members in LVPEF group (1160.6 ±31.8 ms vs.1129.4 ± 39.8 ms, p<0.05). Although, there was no significant correlation between native T1 and LVEFs, it had the trend (p=0.054). The mean mRNA MMP-9 and MMP-9 protein of normal controls LVNC patents were 58.32± 28.19 vs.92.44± 62.26 (p=0.003),58.32± 28.19ng/ml vs.92.44± 62.26ng/ml (p=0.025), respectively. Significant positive correlations were found between native T1 and MMP-9(r=0.40, p=0.044).Conclusions:Native T1 mapping can quantitatively measure compacted myocardial fibrosis in early stage of LVNC patients, and it might help to classify the severity of LVNC patients, In addtion, the native T1 is marginally correlated with systolic function. LVNC patients with family history might have more serious fibrosis. There is a positve correlation between native T1 and MMP-9.Background:At present, studies have shown that compared with LGE, the new technique of native T1 mapping is superior in characterizing diffuse fibrosis and subtle focal lesions. Histological studies demonstrated that diffuse fibrosis can be observed in the compacted myocardium of LVNC patients, but less than 50% LVNC patients with LGE were found by CMR-LGE research. The LGE might underestimate the compacted layer fibrosis in LVNC patients.Aims:To investigate the usefulness of native T1 mapping in the characterization of myocardial abnormalities in LVNC patients as compared with LGE.Materials and Methods:31 LVNC patients and 8 matched age and gender for the normal volunteers were scanned by 3.0 T MR system using a 32-channel phased array heart coil. Cine, PSIR and MOLLI sequences were performed with four chamber view, two chamber view, long and short axis view of left ventricle to acquire Cine images, LGE images and native T1 maps. The patients were divided into 2 groups:with LGE (LGE (+)) and without LGE (LGE (-)). All the data were analyzed by MATLAB according to AHA standard segments.Results:Of 31 LVNC patients,14 had LGE (+).The mean native T1 value of the normal controls, LGE (-) and LGE (+) patients was 1098.8±40.8 ms,1140.6±32.8 ms, and 1181.4±53.7 ms, respectively. Significant differences were found in native T1 between any 2 groups (F=9.74, P<0.001). In discriminating the presence of LGE in LVNC patients, the odds ratio and corresponding 95% confidence interval (CI) of native T1 were, respectively,2.966 (95%CI:1.123-7.835, P=0.028) and 4.348 (95% CI: 1.155-16.363, P=0.030) before and after adjusting for confounding factors with an increment of 1 standard deviation.Conclusions:Native T1 mapping can be used earlier than LGE imaging to detect myocardial fibrosis in LVNC patients. Furthermore, native T1 mapping is more sensitive than LGE imaging for identifying myocardial fibrosis in LVNC patients.Background:The clinical manifestations of the isolated Left ventricular non-compaction (LVNC) vary widely from asymptomatic to heart failure and sudden cardiac death. The main treatments for LVNC are medications of anti-heart failure and preventing complications. While the timing of medication, response to treatment and prognosis is unclear. The results of part 1 and 2 of this study had shown that there was no relationship in patients with LVNC between non-compaction segments and cardiac function, but the significant correlation was found between compacted myocardial fibrosis and systolic function in LVNC patients. We speculate that the tissue characteristics of compaction layers, which evaluated by T1 mapping, would be an important determinant of progress of LVNC, therefore in this part we would prove our assumption by a prospective study in LVNC, and we would also find the cutoff value of native T1 for treatment response and prognosis.Aims:To follow up the disease of LVNC progress and find out the cutoff value of native T1 for prognosis and treatment with good response.Materials and Methods:LVNC patients were diagnosed by two senior cardiologists according to the Jenny echocardiography criteria.31 LVNC patients including in 17 males following up for 24.4±2.4 months. LVNC patients were divided into 2 groups: treatment group and without treatment group. The CINE, PSIR and MOLLI image sequences were used to evaluate the relationships between the fibrosis of compacted myocardium of LVNC and the adverse cardiac events, echocardiograph was used to evaluate the cardiac function. The adverse cardiac events were defined as sudden cardiac death, radiogenic shock, cardiogenic syncope and sick sinus syndrome.Results:Of 14 LVNC patients with LGE,4 patients with adverse cardiac events during the 24.4±2.4 months follow-up. Significant difference was found in native T1 (1226.8±21.4 ms vs.1151.8 ± 46.0 ms, p=0.007) and QTc interval (466.3±40.4ms vs. 427.3±31.3ms, p=0.03) between patients with and without adverse cardiac events. The cutoff T1 value for adverse prognosis was 1203.5 ms with 100% sensibility and 96% specificity in ROC curve (p=0.003). Mass of compaction above 55.6 g/m2 could also be a prognosis markers for LVNC patients with 100% sensibility and 81% specificity in ROC curve (p=0.022). "Response to treatment" was defined the LVEF change above 10% after treatment by echocardiography studies in LVNC patients receiving medical management without adverse outcomes, we found the T1 value for response to medication was 1144.9 ms with 83.3%% sensibility and 80% specificity in ROC curve (p=0.035). The LVEF was increased from 28.9±13.8% to 40.9±13.0%(p=0.001) after treatment. While in non-treatment group LVEF remain stable 62.3±8.1 and 65.9± 6.5%(p=0.266), but LVNC patients with family history showed more trend of increasing left ventricular diastolic dimension((p=0.081)Conclusion:1.The cutoff value of T1 mapping for prognosis was 1203.5 Mrs.2. The cutoff value of T1 mapping for medical response was 1144.9 ms.3. LVNC patients with family history show be follow up more intense(<2 years), while the follow up period of sparse patients need to be determined by large scale studies. |
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