Defining myocardial tissue abnormalities in end-stage renal failure with cardiac magnetic resonance imaging using native T1 mapping

Non-invasive quantification of myocardial fibrosis in end stage renal disease is challenging. Gadolinium contrast agents previously used for cardiac magnetic
resonance imaging are contraindicated because of an association with nephrogenic systemic fibrosis. In other populations increased myocardial native T1 times at cardiac magnetic resonance imaging have been shown to be a surrogate marker of myocardial fibrosis. 33 incident haemodialysis patients and 28 age and sex matched healthy volunteers underwent MRI at 3.0T. We compared native T1 relaxation times and feature tracking derived global longitudinal strain as potential markers of fibrosis and related
them to some cardiac biomarkers. Left ventricular mass indices were higher in the haemodialysis group. Global, Septal and Midseptal T1 times were higher in the haemodialysis group (Global T1 haemodialysis 1171 ± 27ms versus 1154 ± 32ms p=0.025; Septal T1 haemodialysis 1184 ± 29ms versus 1163ms p=0.007; Mid Septal T1 haemodialysis 1184 ± 34ms versus HV 1161 ± 29ms p=0.006.) In the haemodialysis group T1 times correlated with left ventricular mass indices. Septal T1 times correlated with troponin and electrocardiogram corrected QT interval. Peak global longitudinal strain was reduced in the haemodialysis group (haemodialysis -17.7±5.3% versus healthy volunteers -21.8±6.2% p=0.008). For haemodialysis patients peak global longitudinal strain correlated with left ventricular mass indices
(R=0.426, p=0.013) and a trend was seen for correlation with a biomarker of cardiac fibrosis, galectin-3 (R=0.344 p=0.05). We have non-invasively demonstrated tissue properties in the heart of haemodialysis patients that associate with multiple structural and functional abnormalities consistent with myocardial fibrosis.