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The reliability and feasibility of non-contrast adenosine stress cardiovascular magnetic resonance T1 mapping in patients on haemodialysis

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journal contribution
posted on 10.06.2020, 11:02 by Federica E Poli, Gaurav S Gulsin, Daniel S March, Ahmed MSEK Abdelaty, Kelly S Parke, Joanne V Wormleighton, Gerry P McCann, James O Burton, Matthew PM Graham-Brown

Background

Identifying coronary artery disease (CAD) in patients with end-stage renal disease (ESRD) is challenging. Adenosine stress native T1 mapping with cardiovascular magnetic resonance (CMR) may accurately detect obstructive CAD and microvascular dysfunction in the general population. This study assessed the feasibility and reliability of adenosine stress native T1 mapping in patients on haemodialysis.

Methods

The feasibility of undertaking rest and adenosine stress native T1 mapping using the single-shot Modified Look-Locker inversion recovery (MOLLI) sequence was assessed in 58 patients on maintenance haemodialysis using 3 T CMR. Ten patients underwent repeat stress CMR within 2 weeks for assessment of test-retest reliability of native T1, stress T1 and delta T1 (ΔT1). Interrater and intrarater agreement were assessed in 10 patients. Exploratory analyses were undertaken to assess associations between clinical variables and native T1 values in 51 patients on haemodialysis.

Results

Mean age of participants was 55 ± 15 years, 46 (79%) were male, and median dialysis vintage was 21 (8; 48) months. All patients completed the scan without complications. Mean native T1 rest, stress and ΔT1 were 1261 ± 57 ms, 1297 ± 50 ms and 2.9 ± 2.5%, respectively. Interrater and intrarater agreement of rest T1, stress T1 and ΔT1 were excellent, with intraclass correlation coefficients (ICC) > 0.9 for all. Test-retest reliability of rest and stress native T1 were excellent or good (CoV 1.2 and 1.5%; ICC, 0.79 and 0.69, respectively). Test-retest reliability of ΔT1 was moderate to poor (CoV 27.4%, ICC 0.55). On multivariate analysis, CAD, diabetes mellitus and resting native T1 time were independent determinants of ΔT1 (β = − 0.275, p = 0.019; β = − 0.297, p = 0.013; β = − 0.455; p < 0.001, respectively).

Conclusions

Rest and adenosine stress native T1 mapping is feasible and well-tolerated amongst patients with ESRD on haemodialysis. Although rater agreement of the technique is excellent, test-retest reliability of ΔT1 is moderate to poor. Prospective studies should evaluate the relationship between this technique and established methods of CAD assessment and association with outcomes.

Funding

This study is independent research arising from a Clinician Scientist Award (Dr James Burton, CS-2013-13-014) supported by the NIHR, and a grant from Kidney Research UK (Research Innovation Grant IN02/2013). This work is also supported by the NIHR Leicester Biomedical Research Centre, and the NIHR Clinical Research Facility. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.

History

Citation

Poli, F., Gulsin, G., March, D. et al. The reliability and feasibility of non-contrast adenosine stress cardiovascular magnetic resonance T1 mapping in patients on haemodialysis. J Cardiovasc Magn Reson 22, 43 (2020). https://doi.org/10.1186/s12968-020-00634-y

Version

VoR (Version of Record)

Published in

Journal of Cardiovascular Magnetic Resonance

Volume

22

Issue

1

Pagination

43

Publisher

Springer Science and Business Media LLC

eissn

1532-429X

Acceptance date

08/05/2020

Copyright date

2020

Notes

The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Language

en

Publisher version

https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-020-00634-y