title: T1 and T2 mapping for evaluation of myocardial involvement in patients with ANCA-associated vasculitides.
abstract: BACKGROUND
  Myocardial involvement in AAV patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF). Since up to 50% of deaths in these patients may be due to myocardial involvement, a reliable diagnostic tool is warranted. In contrast to LGE-CMR, which has its strengths in detecting focal inflammatory or fibrotic processes, recent mapping techniques are able to detect even subtle, diffuse inflammatory or fibrotic processes. Our study sought to investigate ANCA (antineutrophil cytoplasmic antibody) associated vasculitides (AAV) patients for myocardial involvement by a cardiovascular magnetic resonance (CMR) protocol, including late gadolinium enhancement (LGE) and mapping sequences.
  
  
  METHODS
  Thirty seven AAV patients were prospectively enrolled and underwent CMR imaging. Twenty healthy volunteers served as controls.
  
  
  RESULTS
  Mean LV-EF was 64%; LGE prevalence of the AAV patients was 43%. AAV patients had higher median native T1 (988 vs. 952 ms, p < 0.001), lower post-contrast T1 (488 vs. 524 ms, p = 0.03), expanded extracellular volume (ECV) (27.5 vs. 24.5%, p < 0.001), and higher T2 (53 vs. 49 ms, p < 0.001) compared to controls, with most parameters independent of the LGE status. Native T1 and T2 in AAV patients showed the highest prevalence of abnormally increased values beyond the 95% percentile of controls.
  
  
  CONCLUSIONS
  AAV patients demonstrated increased T1, ECV, and T2 values, with native T1 and T2 showing the highest prevalence of values beyond the 95% percentile of normal. Since these findings seem to be independent of LGE, mapping techniques may provide complementary information to LGE-CMR in the assessment of myocardial involvement in patients with AAV.
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. simon.greulich@rbk.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Greulich
authors.affiliation: Division of Radiology, University Hospital Innsbruck, Innsbruck, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mayr
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.affiliation: Center for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Henes
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Steubing
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaesemann
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Patrascu
authors.affiliation: Siemens Healthcare GmbH, Erlangen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greiser
authors.affiliation: Siemens Healthcare GmbH, Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Groeninger
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016022:Case-Control Studies; D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000175:diagnosis; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA / Q000008:administration & dosage; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: ANCA-associated vasculitides; CMR; Cardiac involvement; LGE; T1 mapping; T2 mapping