Gadolinium-Free Cardiovascular Magnetic Resonance Stress T1 Mapping in Patients With Chronic Kidney Disease

Background: Cardiovascular disease is the most common cause of mortality in patients with chronic kidney disease (CKD). Purpose: Investigate the diagnostic utility of Stress/Rest CMR T1 mapping in differentiating myocardial segments with ischaemia and infarction from remote and normal myocardium in CKD patients. Methods: 20 CKD patients with Egfr <30 mL/min/1.73 m2 or dialysis and left ventricular ejection fraction (LVEF) <45% (9 with CAD, 15 with Diabetes mellitus) and 7 healthy age-matched controls underwent scanning in a 3-T MR scanner. Rest and Stress T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) in three short axis slice positions (basal, mid-ventricular and apical CMR analysis was performed with CMR42 versions 5.6.3 and 5.9.3. The T1 change (ΔT1) was calculated as:ΔT1=(T1Stress−T1Rest)/T1Rest×100% Results: When compared to normal controls, patients with CKD had higher resting T1 values (1206 ± 66 msec vs 1151 ± 50 msec, p ≤ 0.001) and impaired ΔT1 (4.0 ± 4.8% vs 7.1 ± 3.8%, p ≤ 0.001). CKD patients with CAD had significantly lower ΔT1 when compared to CKD patients without CAD (1.7 ± 3.9% vs 5.8 ± 4.6%, p ≤ 0.001). The resting T1 values for remote, ischaemic and infarcted myocardium were 1204 ± 62 msec, 1198 ± 66 msec, and 1281 ± 97 msec and ΔT1 values were 4.7 ± 4.5%, 1.0 ± 4.1%, and −1.1 ± 6.1% respectively. Conclusion: Stress T1 is impaired in the CKD population. Our results are hypothesis-generating and need to be confirmed with larger studies.