“Myocardial transit-time” (MyoTT): a novel and easy-to-perform CMR parameter to assess microvascular disease

• Published in: Clinical research in cardiology Vol. 109; no. 4; pp. 488 - 497
• Main Authors: Chatzantonis, Grigorios, Bietenbeck, Michael, Florian, Anca, Meier, Claudia, Korthals, Dennis, Reinecke, Holger, Yilmaz, Ali
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2020; Springer Nature B.V
• Subjects: Adult; Aged; Aorta; Arteries; Blood circulation; Blood Flow Velocity; Cardiology; Cardiomyopathy; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - physiopathology; Case-Control Studies; Contrast agents; Contrast Media - administration & dosage; Coronary artery disease; Coronary Circulation; Disease control; Female; Gadolinium; Heart diseases; Heart rate; Humans; Magnetic resonance; Magnetic Resonance Imaging, Cine; Male; Medicine; Medicine & Public Health; Microcirculation; Microvasculature; Middle Aged; Myocardial Perfusion Imaging; Organometallic Compounds - administration & dosage; Orifices; Original Paper; Parameters; Perfusion; Predictive Value of Tests; Time Factors; Transit; Ventricle; Wall thickness; CMR; HCM; CMD; Microvascular disease; Myocardial perfusion; MyoTT
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-019-01530-x

Background Myocardial microvascular disease may occur during the disease course of different cardiac as well as systemic disorders. With the present study, we introduce a novel and easy-to-perform cardiovascular magnetic resonance (CMR) parameter named “myocardial transit-time” (MyoTT). Methods N  = 20 patients with known hypertrophic cardiomyopathy (HCM) and N  = 20 control patients without relevant cardiac disease underwent dedicated CMR studies on a 1.5-T MR scanner. The CMR protocol comprised cine and late-gadolinium-enhancement (LGE) imaging as well as first-pass perfusion acquisitions at rest for MyoTT measurement. MyoTT was defined as the blood circulation time from the orifice of the coronary arteries to the pooling in the coronary sinus (CS), and accordingly measured as the temporal difference between the appearances of CMR contrast agent in the aortic root and the CS reflecting the transit-time of gadolinium in the myocardial microvasculature. Results Patients with HCM had a significantly prolonged MyoTT compared to controls (11.0 (9.1–14.5) s vs. 6.5 (4.8–8.4) s, p  < 0.001). This significant difference did not change when the individual heart rate was taken into consideration (MyoTT indexed, p  < 0.001). Significant correlations were found between MyoTT and maximal left ventricular (LV) wall thickness ( r  = 0.771, p  < 0.001), MyoTT and presence of LGE ( r  = 0.760, p  < 0.001) as well as MyoTT and LV global longitudinal strain ( r  = 0.672, p  < 0.001). ROC analysis resulted in an area-under-curve (AUC) of 0.90 for MyoTT and showed an optimal sensitivity/specificity cut-off of 7.85 s to differentiate HCM from controls. Conclusion “Myocardial transit-time” is a novel and easy-to-perform CMR parameter that allows a quick assessment of the extent of myocardial microvascular disease. This novel CMR parameter may open new vistas in the assessment of microvascular disease—not only in HCM patients. Future studies will show the usefulness and clinical relevance of this novel CMR parameter. Graphic abstract