Yuesong Yang MD, PhD, Presenter: Nothing to Disclose

Anna Elizabeth Helen Zavodni MD, MPH, Abstract Co-Author: Nothing to Disclose

Warren D. Foltz PhD, Abstract Co-Author: Nothing to Disclose

Venkat Ramanan, Abstract Co-Author: Nothing to Disclose

Lucas Vivas, Abstract Co-Author: Nothing to Disclose

Idan Roifman, Abstract Co-Author: Nothing to Disclose

Laura Jimenez-Juan MD, Abstract Co-Author: Nothing to Disclose

Gorka Bastarrika MD, Abstract Co-Author: Speaker, Bayer AG Speaker, Siemens AG

Graham Wright PhD, Abstract Co-Author: Research Grant, General Electric Company Advisory Board, General Electric Company Speaker, General Electric Company

Kim Connelly, Abstract Co-Author: Nothing to Disclose

Diabetes (DM)-related myocardial changes of myocardial fibrosis and collagen deposition may lead to increased myocardial extracellular volume fraction (ECV) and myocardial stiffness. In this study, we hypothesize that increased ECV measured with quantitative CMR methods in DM patients will correlate with LV diastolic dysfunction.

17 DM patients (6 males, age 63±10 years old) without macrovascular complications were examined on a 1.5T MR system. A short-axis SSFP stack was used to determine LV function, a pre-contrast T1 prep or a modified Look-Locker sequence was performed in a mid-LV level from which a T1 map and average LV myocardium T1 was derived. Post-contrast LGE-CMR was performed 15 minutes post injection of Gd-DTPA. A repeated T1 mapping as the pre-contrast T1 measurement was acquired around 20 min post-contrast. LV systolic function and LGE determination used software CMR42. LV diastolic function including peak filling rate (PFR) and time to peak filling rate (TPFR) was calculated using MASS software and was blinded to T1 analysis. T1 calculation used CMR42 or a customized Matlab code. Myocardial ECV = (1-haematocrit) × (ΔR1myocardium/ΔR1blood). Increased ECV was defined as ECV > 30%.

The average LV function in 17 subjects were in the normal range (LVEF=61±6%, LVESV=45±17 ml, LVEDV=113±33 ml, LVSV=68±19 ml, LVM=103±25 g). No focal LGE was observed in this patient cohort. 8 of 17 subjects had ECV> 30% (38±9%) and the other 7 subjects had ECV<30% (23±5%). There is no statistically significant difference (P>0.05) in LV systolic function of LVEF, LVESV, LVEDV, LVSV and LVM between the increased ECV and normal ECV group. However, a statistically significant difference (P<0.05) was observed among diastolic functional parameters of TPFR and PFR, with significantly longer TPFR (344±148 vs.156±32 ms) and lower PFR (220±50 vs. 295±74 ml/s) observed in the increased ECV group. Also a statistically significant difference (P<0.05) was observed in pre-contrast T1 measurements.

Increased ECV was observed in diabetic patients with preserved systolic function and this was associated with altered LV diastolic function. The increased ECV may indicate the presence of diffuse interstitial fibrosis and myocardial stiffness, thus limiting the LV diastolic relaxation.

Quantitative T1 mapping may be useful for the detection of  increased ECV which is associated with LV diastolic dysfunction.

Yang, Y, Zavodni, A, Foltz, W, Ramanan, V, Vivas, L, Roifman, I, Jimenez-Juan, L, Bastarrika, G, Wright, G, Connelly, K, Increased Myocardial Extracellular Volume Fraction in Diabetic Patients Is Associated with LV Diastolic Dysfunction: A CMR Feasibility Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004894.html