1. Wei Wang, Long Jiang Zhang*, Guang Ming Lu*
Initial study of myocardial fibrosis in patients with CKD by using T1 mapping
Wei Wang, Long Jiang Zhang*, Guang Ming Lu*
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu
*Corresponding authors
Backgroud and purpose: Chronic kidney disease (CKD) encompasses all renal disease states from the earliest stage through to end-stage renal disease (ESRD). The risk of cardiovascular death in CKD far exceeds the risk of progressing to dialysis; therefore, treatment should be focused at least as much on reducing this risk as on reducing the rate of progression of renal disease. Postmortem and biopsy studies have demonstrated that patients with CKD have high levels of interstitial myocardial fibrosis, which lead to adverse changes in cardiac structure and function. Native myocardial T1 relaxation time and myocardial extracellular volume (ECV), measured by T1 mapping, are novel indicators to assess myocardial fibrosis. This study aimed to evaluate myocardial fibrosis in patients with 1-5 stage CKD using T1 mapping technique of cardiovascular magnetic resonance (CMR) imaging.
Materials and methods: This investigative study prospectively enrolled twenty-two patients (thirteen subjects with 1-4 stage CKD and nine patients with ESRD) and fourteen control individuals. There were eight subjects with ESRD have received hemodialysis therapy and seven individuals among them have received the kidney transplant. Five patients have undergone a follow-up in a period ( days) after renal transplant. Segmental and average native myocardial T1 times were compared between patient group and control group, pre- and post-transplant, respectively.
Results: Native T1 time was significantly higher in the patient group than the control group in basal (1312.6±59.8 ms vs ±29.6 ms, P=0.001), mid (1311.4±59.8 ms vs ±37.7 ms, P=0.002), apical (1350.9±72.2 ms vs ±58.5 ms, P=0.003) and average (1325.0±58.5 ms vs ±36.2 ms, P=0.001), respectively. Native T1 time of post-transplant was significantly lower than pre-transplant in basal (1297.9±75.1 ms vs ±37.1 ms, P=0.022), mid (1315.2±72.8 ms vs ±20.0 ms, P=0.041), apical (1343.0±59.3 ms vs ±31.2 ms, P=0.006) and average (1318.7±65.1 ms vs ±24.3 ms, P=0.013), respectively. Compared with the pre-transplant ECV, the post-transplant ECV have reduced in two patients, but increased in the other patient.
Conclusions: Native T1 time is a sensitive indicator to noninvasively assess myocardial fibrosis in patients with CKD and to evaluate the prognosis of myocardial fibrosis after renal transplant. Efficiency of ECV to evaluate myocardial fibrosis needs to be furtherly verified between patients and controls, pre- and post-transplant.
Keywords: Myocardial fibrosis, Chronic kidney disease, End-stage renal disease, Native T1 time, Extracellular volume 格式
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展示于2017国际心血管磁共振协会中国区委员会第三界学术论坛，2017年8月4-7日 中国. 上海

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Presented at the 3rd SCMR China Symposium, in Shanghai, China, August 4-7, 2017