{"paper_id":"024acc84-3abe-4645-aaef-b41ab251f53b","body_text":"Evaluation of right ventricular myocardial properties using systolic myocardial T1 mapping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of right ventricular myocardial properties using systolic myocardial T1 mapping Yuki Sasaki, Hideharu Oka, Kouichi Nakau, Yuki Shibagaki, Keita Ito, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3860686/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Myocardial properties can be quantitatively evaluated using myocardial T1 values obtained using cardiac magnetic resonance imaging. In terms of myocardial wall thickness, the left ventricular T1 value is easy to measure, but the right ventricular T1 value is difficult. Patients with congenital heart disease often develop right ventricular overload. We aimed to determine whether T1 mapping during systole can be used to evaluate right ventricular myocardial properties. Methods: T1 mapping was performed at diastole and systole, and the myocardial properties of both ventricles were evaluated in 13 healthy participants (21–26 years old) and 12 patients with right ventricular overload (12–41 years old) who underwent cardiac magnetic resonance imagingexamination at our hospital. Results: From analysis of left ventricular myocardial T1 values, we found that myocardial T1 values did not change significantly during the cardiac cycle. But, right ventricular T1 values changed between diastole and systole because the right ventricle is affected by blood. Although there was no difference in right ventricular diastolic myocardial T1 values between the patients and volunteers (1346.8 vs. 1347.6 msec, p=0.852), the right ventricular systolic myocardial T1 values was significantly higher in patients than in volunteers (1312.7 vs. 1233.8 msec, p=0.002). Conclusion: Systolic right ventricular myocardial T1 mapping allows assessment of right ventricular myocardial properties. The right ventricular myocardial systolic T1 value is useful for evaluating myocardial damage due to right ventricular stress and myocardial injury. T1 mapping systolic phase right ventricular myocardium right ventricular overload cardiac MRI. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The prognosis of patients with congenital heart disease (CHD) has improved thanks to advances in medical technology [ 1 ]. The number of patients survivors with CHD continues to increase by approximately 10,000 annually in Japan, and the number of adults with CHD is also increasing [ 2 ]. Various problems occur in the long term after surgery for CHD, and right heart failure is one of the pathologies that should be noted. Right heart failure is determined by dilation of the right ventricle and decreased contractile force; if it worsens, reoperation is required [ 3 ]. Reaching the criteria for reoperation may take years, and progress is often observed during this time. However, during this period, the right ventricular myocardium gets damaged, and it is difficult to evaluate the degree of damage to the myocardium. In recent years, T1 mapping has become popular in cardiac magnetic resonance imaging (CMR) examinations, enabling quantitative evaluation of myocardial properties [ 4 ]. Although evaluation of myocardial fibrosis using delayed contrast imaging was standard, it included problems such as the inability to detect diffuse lesions and the need for a contrast agent [ 5 ]. T1 mapping can measure the myocardial T1 value without contrast agent and evaluate diffuse lesions, therefore, objective investigation of changes in myocardial properties is possible. Myocardial T1 values are known to increase in the presence of myocardial inflammation or fibrosis and amyloidosis, whereas they decrease in the presence of iron and fat deposits and in Fabry's disease [ 6 ]. Care must be taken to avoid a non-specific increase in myocardial T1 values due to blood when measuring the myocardial T1 values [ 7 ]. Since the T1 value of blood is higher than that of the myocardium, if the region of interest (ROI) is surrounded by blood components, the T1 value will increase significantly. As for the left ventricle, the thickness of the myocardial wall is sufficient; therefore, blood components are less of a problem when surrounding the ROI. On the other hand, in the right ventricle, the myocardial wall is thin, and the endocardial surface is rough. Therefore, the boundary between the blood and myocardial components tends to be unclear, making it difficult to measure the right ventricular myocardial T1 value [ 8 ]. If this problem can be overcome and T1 mapping can be used to quantitatively evaluate right ventricular myocardial properties, it may be useful for understanding the pathology of the right heart system. Therefore, we aimed to measure the right ventricular myocardial T1 value by T1 mapping during systole, which is normally performed during diastole. Methods We conducted a retrospective study that included patients who underwent CMR in the Department of Pediatrics of Asahikawa Medical University Hospital between March 2020 and December 2023. The patients underwent MRI for hemodynamic parameter evaluation as part of routine follow-up or surgical planning and examined diastolic and systolic T1 mapping. There were 192 patients and we excluded 85 patients who underwent CMR by free-breathing method, 65 patients without systolic right ventricular T1 mapping, 22 patients without right ventricular overload, and 8 patients before radical surgery (Fig. 1 ). We investigated 12 patients (12–41 years old) with right ventricular overload and they were as follows: tetralogy of Fallot (n = 5), transposition of the great artery (n = 3), idiopathic pulmonary artery hypertension (n = 2), double outlet right ventricle (n = 1), and pulmonary atresia with intact ventricular septum (n = 1). Thirteen volunteers (21–26 years old) who underwent CMR examination at were included. The healthy subjects underwent echocardiography in advance to confirm that there were no problems with the intracardiac structural abnormalities or cardiac function. This study was conducted in compliance with the standards of the Declaration of Helsinki and the current ethical guidelines and was approved by our institutional ethics board (no. 21163). Written informed consent was obtained from all participants. All cardiac imaging examinations were performed using MAGNETOM Vida (Siemens Healthcare, Erlangen, Germany) with a 3.0 Tesla MR system. The modified Look-Locker inversion recovery (MOLLI) sequence with motion correction was used for T1 mapping. The images required for T1 mapping were taken in one-six cardiac short-axis slices (basal, mid, and apex). T1 mapping was performed under breath-holding conditions in all patients. The other scan parameters were as follows: field of view, 360×360 mm; slice thickness, 8 mm; flip angle, 35°; matrix size, 256×144; base resolution, 256; phase resolution, 144 (66%); reduce field of view, 85.2%; pixel size, 1.4×1.4×8.0mm 3 ; acceleration factor, 2; echo time, 1.06 msec, repetition time, 2.53 msec; and shot mode, true fast imaging with steady-state precession pulse sequence using the 5b(3b)3b scheme. A workstation (Cvi42, Circle, Cardiovascular Imaging, Calgary, Canada) was used for analysis. We cannot take systolic T1 mapping due to initial MRI settings. So, in our study, systolic T1 mapping was performed using the following method (Fig. 2 ). We calculated the time difference between the setting time on the device side when capturing the diastolic T1 mapping and the capture time of the completed diastolic T1 mapping images. This difference is the time required for the T1 mapping process. By subtracting this time difference from the systolic imaging time of the cine MRI image, it became possible to determine the setting time of the systolic T1 mapping on the device side, and the systolic T1 mapping images became possible. When we obtained the setting time and imaging time on the device side of the diastolic T1 mapping of 22 participants who had been studied, the setting time on the device side was 236.2 ± 132.4 msec, the shooting time was 421.0 ± 132.6 msec, and the time difference was found to be 184.8 ± 0.84 msec. Therefore, the setting time on the device side for systolic T1 mapping was calculated by subtracting 185 msec from the systolic imaging time of cine MRI to enable the systolic T1 mapping images. We confirmed visually that the systolic T1 mapping images taken as described above were in the systolic phase. All parameters are expressed as mean ± standard deviation. Statistical differences were determined using the Mann–Whitney U and Wilcoxon signed-rank. Statistical significance was set at P < 0.05. Statistical calculations were performed using Statistical Package for the Social Sciences (version 28.0; IBM Corp., Armonk, NY, USA). Results The characteristics of participants in this study are presented in Table 1 . We investigated whether the myocardial T1 value changed because of the difference in the cardiac cycle using the left ventricular myocardial T1 value (Table 1 , Fig. 3 –4). The diastolic myocardial T1 value of the ventricular septal wall in the 13 healthy subjects was 1216.0 ± 40.5 msec, and the systolic myocardial T1 value was 1214.8 ± 27.1 msec, showing no significant difference (p = 0.754) (Fig. 4). In addition, the diastolic myocardial T1 value of the lateral wall of the left ventricle was 1161.3 ± 49.9 msec, and the systolic myocardial T1 value was 1167.2 ± 37.1 msec, neither of which was significantly different (p = 0.447) (Fig. 4). We found that myocardial T1 values did not change significantly during the cardiac cycle. Myocardial T1 values in the lateral wall of the left ventricle were significantly lower than those in the septal wall, both diastolic and systolic phase (diastole, p = 0.003; systole, p = 0.002). There was no difference in left ventricular T1 values by cardiac cycle in the patient group, nor was there a significant difference in left ventricular T1 values compared to the healthy subjects (Fig. 4). Table 1 Demographic and T1 mapping data Volunteers (n = 13) Patients (n = 12) p Sex (male : female) 11 : 2 8 : 4 0.378 Age (years) 23.5 ± 1.3 21.7 ± 9.2 0.052 Height (cm) 167.2 ± 6.9 162.6 ± 11.3 0.347 Body weight (kg) 58.4 ± 6.9 52.9 ± 11.8 0.347 Heart rate (bpm) 70.7 ± 7.5 80.2 ± 11.5 0.030 Diastolic LV septal T1 values (msec) 1216.0 ± 40.5 1238 ± 41.1 0.247 LV lateral T1 values (msec) 1161.3 ± 49.9 1120 ± 41.2 0.152 RV T1 values (msec) 1347.6 ± 86.5 1346.8 ± 96.7 0.852 Systolic LV septal T1 values (msec) 1214.8 ± 27.1 1238.2 ± 39 0.247 LV lateral T1 values (msec) 1167.2 ± 37.1 1199.2 ± 29.6 0.077 RV T1 values (msec) 1233.8 ± 58.9 1312.7 ± 34.5 0.002 LV; left ventricular, RV; right ventricular. Normal systolic right ventricular myocardial T1 values were measured using systolic right ventricular T1 mapping in the healthy subjects and Fig. 3 shows T1 mapping images of the healthy subject and patient group. The right ventricular myocardial T1 value was determined by setting ROIs in areas where the myocardium of the right ventricular free- and inferior walls is sufficiently thick to avoid the effects of blood. As a result, the normal systolic right ventricular free- and inferior walls myocardial T1 values were 1234.8 ± 42.4 msec and 1235.6 ± 36.7 msec, respectively (p = 0.795). Hence, normal right ventricular myocardium did not differ in systolic T1 values depending on the site of measurement. On the other hand, in the diastolic phase, the right ventricular myocardial T1 value in the healthy subject was 1347.6 ± 86.5 msec, and the right ventricular myocardial T1 value in the right ventricular overloaded group was 1346.8 ± 96.7 msec, which was no difference (p = 0.852, Fig. 5 ). In the systolic phase, the right ventricular myocardial T1 value in the healthy subject was 1233.8 ± 58.9 msec, and the right ventricular myocardial T1 value in the right ventricular overloaded group was 1312.7 ± 34.5 msec, which was significant difference (p = 0.002, Fig. 5 ). Discussion In this study, we found that systolic T1 mapping could be obtained from diastolic T1 mapping and cine MRI images, there was little change in myocardial T1 value due to the cardiac cycle, and the systolic right ventricular myocardial T1 value was high in patients with right ventricular overload. Under standard settings, the cardiac cycle is determined from the QRS complex, and T1 mapping is performed during diastole [ 9 – 10 ]. Therefore, systolic imaging should be devised, as in this study. Our results suggest almost no difference in T1 mapping processing time between individuals, and systolic T1 mapping was possible by subtracting 185 msec from the systolic time of the cine MRI images. It is necessary to examine whether this value of 185 msec remains the same for other MRI devices in the future. Once the processing time for T1 mapping is obtained at one's facility, systolic T1 mapping can always be obtained from cine MRI images, which is very useful. When setting the systolic time, Ursula et al. examined systolic T1 mapping by shifting a certain amount of time from diastole [ 11 ]. In that method, changes in heart rate cause a shift in systolic timing. Therefore, our method is better at setting systolic timing independent of heart rate. In addition, we found that the myocardial T1 value hardly changed during the cardiac cycle. Carlo et al. reported no difference in left ventricular myocardial T1 values between diastole and systole [ 12 ]. In contrast, Ursula et al. reported that the myocardial T1 value significantly decreased during systole than during diastole, but the difference was approximately 2.5%, which is unlikely to be clinically significant [ 11 ]. The slight change in myocardial T1 value with the cardiac cycle indicates no problem in evaluating the right ventricular myocardial T1 value in either the diastolic or systolic cardiac cycle. In determining the normal right ventricular myocardial T1 value, it is difficult to measure the diastolic right ventricular myocardial T1 value in healthy subjects. Because the right ventricular myocardium has a thin myocardial wall and rough endocardial surface, the myocardium is insufficiently thick to surround the myocardial ROI and is susceptible to blood-induced T1 elevation. Because the myocardial wall is thicker during systole than diastole, the free and inferior walls of the right ventricle increase the number of sites where the ROI can be obtained. Despite this, the measurement locations are often limited. When considering setting normal values, it is important to take multiple cross sections to increase the number of measurable locations as we did. Regarding the site of myocardial T1 measurement, our results showed a significant difference between the left ventricular septal and posterior walls, consistent with a previous report [ 5 ]. The myocardial T1 value of the left ventricular posterior wall is known to be lower than that of the septal wall owing to the effects of cardiac motion [ 5 ]. Similar results were expected for the right ventricular myocardium. However, there was no significant difference in myocardial T1 values between the right ventricular free and inferior walls during systole in healthy subjects. Therefore, if it is difficult to obtain the myocardial T1 value on the free wall, there is no significant problem in evaluating the myocardial T1 value on the inferior wall. It is desirable to evaluate the same location over time. Consistent with previous reports, patients with right ventricular myocardial injury had elevated right ventricular myocardial T1 values [ 13 – 14 ]. The right ventricular myocardial T1 value is known to be elevated in patients with pulmonary hypertension and after surgery for tetralogy of Fallot. But, in previous reports, the right ventricular myocardial T1 value was evaluated during diastole [ 13 – 14 ]. The validity of the diastolic right ventricular myocardial T1 value has been cited as a limitation in all the previous reports. Among patients with right ventricular overload, especially those with right ventricular pressure overload, the thickness of the right ventricular myocardium is sufficient even during diastole due to right ventricular hypertrophy. Therefore, measurement of the myocardial T1 value is almost unaffected by blood and can be measured accurately. As mentioned earlier, it is challenging to measure the normal T1 value in diastolic right ventricular myocardium. Without knowing normal values, it is not possible to evaluate right ventricular T1 values in disease groups. Even in patients with a thick right ventricular myocardium, it is possible to compare with normal values by imaging systolic T1 mapping and quantitative evaluation of right ventricular myocardial damage can now be performed. One of the limitations of this study is the small number of cases. In particular, there are limited data on healthy subjects. Since myocardial T1 changes are known to depend on sex and age, it is necessary to increase the number of cases in the future and determine the normal value of right ventricular myocardial T1 during systole. Also, due to the small number of cases, we were unable to separate patient groups into pressure or volume overload. It is necessary to study with a large number of patients in the future. Second, it is difficult to measure the right ventricular myocardial T1 value. The right ventricular myocardium of healthy subjects was measured as a normal myocardium at any site. There might be a difference depending on the site in the patient group. To ensure sufficient thickness of the right ventricular myocardium, even during systole, it is considered appropriate to evaluate systolic T1 mapping only in patients with right ventricular overload, and further investigation is required. We quantitatively evaluated the properties of the right ventricular myocardium by right ventricular myocardial T1 mapping during systole. The right ventricular myocardial T1 value can be evaluated by measuring it during systole rather than diastole and can be useful for evaluating myocardial damage. Declarations Disclosures The authors have no conflicts of interest to disclose. Funding This research did not receive specific grants from any funding agency, or commercial or non-profit entities. Author Contribution Y.S. and H.O. conceptualized and designed the study, drafted the initial manuscript, carried out the initial analyses, and critically reviewed and revised the manuscript.Y.S. and K.I. and R.I. and S.S. and Y.A. and K.F. and S.N. and K.I. designed the data collection instruments, collected data, and critically reviewed and revised the manuscript.K.N. and S.T. designed the data collection instruments, coordinated and supervised data collection, and critically reviewed and revised the manuscript.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Acknowledgment We would like to thank Editage ( www.editage.com ) for English language editing. References Stout KK, Daniels CJ, Aboulhosn JA et al (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 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J Cardiovasc Magn Reson 19:75 Piechnik SK, Ferreira VM, Lewandowski AJ et al (2013) Normal variation of magnetic resonance T1 relaxation times in the human population at 1.5 T using ShMOLLI. J Cardiovasc Magn Reson 15:13 Rauhalammi SMO, Mangion K, Barrientos PH et al (2016) Native myocardial longitudinal (T1) relaxation time: regional, age, and sex associations in the healthy adult heart. J Magn Reson Imagin 44:541–548 Taylor AJ, Salerno M, Dharmakumar R et al (2016) T1 mapping: Basic techniques and clinical applications. JACC Cardiovasc Imaging 9:67–81 Biglands JD, Radjenovic A, Ridgway JP (2012) Cardiovascular magnetic resonance physics for clinicians: part II. J Cardiovasc Magn Reson 14:66 Reiter U, Reiter G, Dorr K et al (2014) Normal diastolic and systolic myocardial T1 values at 1.5-T MR imaging: correlations and blood normalization. Radiology 271:365–372 Tessa C, Diciotti S, Landini N et al (2015) Myocardial T1 and T2 mapping in diastolic and systolic phase. Int J Cardiovasc Imag 31:1001–1010 Shiina Y, Taniguchi K, Nagao M et al (2020) The relationship between extracellular volume fraction in symptomatic adults with tetralogy of Fallot adverse cardiac events. J Cardiol 75:424–431 Asano R, Ogo T, Morita Y et al (2021) Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertention. PLoS ONE 16 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3860686\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":267125336,\"identity\":\"50da2dba-858f-437a-a6ac-766ad93fefb2\",\"order_by\":0,\"name\":\"Yuki Sasaki\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Asahikawa Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yuki\",\"middleName\":\"\",\"lastName\":\"Sasaki\",\"suffix\":\"\"},{\"id\":267125337,\"identity\":\"cfa952f0-d301-4ebb-ac6f-560a4133581f\",\"order_by\":1,\"name\":\"Hideharu 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flow\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3860686/v1/d3b553bf5ae7f44e2d6a3dd9.png\"},{\"id\":49767079,\"identity\":\"cab3d8f4-a915-46e0-bb22-98b745efe945\",\"added_by\":\"auto\",\"created_at\":\"2024-01-17 17:11:27\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":265500,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSetting of systolic T1 mapping.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3860686/v1/718e70bcde86f5c3d49032f5.png\"},{\"id\":49767080,\"identity\":\"eff8cce8-0a5c-4800-8387-092c267a6ec2\",\"added_by\":\"auto\",\"created_at\":\"2024-01-17 17:11:27\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":2224962,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDiastolic and systolic T1 mapping images. Circles indicate measurement sites.\\u003c/p\\u003e\\n\\u003cp\\u003eiPAH; idiopathic pulmonary artery hypertension.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3860686/v1/6390f280d9ed35df3aa1c710.png\"},{\"id\":49767082,\"identity\":\"63b00545-98e8-4092-945f-148def631bb7\",\"added_by\":\"auto\",\"created_at\":\"2024-01-17 17:11:27\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":90930,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparison of left ventricular diastolic and systolic myocardial T1 values.\\u003c/p\\u003e\\n\\u003cp\\u003eDia; diastolic phase, Sys; systolic phase.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3860686/v1/e4411510f1213357cd02ef4e.png\"},{\"id\":49767078,\"identity\":\"694eeec4-913e-4df2-8421-2bd7b78ad6a2\",\"added_by\":\"auto\",\"created_at\":\"2024-01-17 17:11:27\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":49467,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparison of right ventricular diastolic and systolic myocardial T1 values.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3860686/v1/1f548d150fde9ffbe8d63722.png\"},{\"id\":49770355,\"identity\":\"55921aca-62d4-494e-ab90-7d5f5a393af5\",\"added_by\":\"auto\",\"created_at\":\"2024-01-17 17:35:39\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2504919,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3860686/v1/35ce2782-3b68-46c8-952d-626150a7d86d.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Evaluation of right ventricular myocardial properties using systolic myocardial T1 mapping\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe prognosis of patients with congenital heart disease (CHD) has improved thanks to advances in medical technology [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The number of patients survivors with CHD continues to increase by approximately 10,000 annually in Japan, and the number of adults with CHD is also increasing [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Various problems occur in the long term after surgery for CHD, and right heart failure is one of the pathologies that should be noted. Right heart failure is determined by dilation of the right ventricle and decreased contractile force; if it worsens, reoperation is required [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Reaching the criteria for reoperation may take years, and progress is often observed during this time. However, during this period, the right ventricular myocardium gets damaged, and it is difficult to evaluate the degree of damage to the myocardium.\\u003c/p\\u003e \\u003cp\\u003eIn recent years, T1 mapping has become popular in cardiac magnetic resonance imaging (CMR) examinations, enabling quantitative evaluation of myocardial properties [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Although evaluation of myocardial fibrosis using delayed contrast imaging was standard, it included problems such as the inability to detect diffuse lesions and the need for a contrast agent [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. T1 mapping can measure the myocardial T1 value without contrast agent and evaluate diffuse lesions, therefore, objective investigation of changes in myocardial properties is possible. Myocardial T1 values are known to increase in the presence of myocardial inflammation or fibrosis and amyloidosis, whereas they decrease in the presence of iron and fat deposits and in Fabry's disease [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Care must be taken to avoid a non-specific increase in myocardial T1 values due to blood when measuring the myocardial T1 values [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Since the T1 value of blood is higher than that of the myocardium, if the region of interest (ROI) is surrounded by blood components, the T1 value will increase significantly. As for the left ventricle, the thickness of the myocardial wall is sufficient; therefore, blood components are less of a problem when surrounding the ROI. On the other hand, in the right ventricle, the myocardial wall is thin, and the endocardial surface is rough. Therefore, the boundary between the blood and myocardial components tends to be unclear, making it difficult to measure the right ventricular myocardial T1 value [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIf this problem can be overcome and T1 mapping can be used to quantitatively evaluate right ventricular myocardial properties, it may be useful for understanding the pathology of the right heart system. Therefore, we aimed to measure the right ventricular myocardial T1 value by T1 mapping during systole, which is normally performed during diastole.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eWe conducted a retrospective study that included patients who underwent CMR in the Department of Pediatrics of Asahikawa Medical University Hospital between March 2020 and December 2023. The patients underwent MRI for hemodynamic parameter evaluation as part of routine follow-up or surgical planning and examined diastolic and systolic T1 mapping. There were 192 patients and we excluded 85 patients who underwent CMR by free-breathing method, 65 patients without systolic right ventricular T1 mapping, 22 patients without right ventricular overload, and 8 patients before radical surgery (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). We investigated 12 patients (12\\u0026ndash;41 years old) with right ventricular overload and they were as follows: tetralogy of Fallot (n\\u0026thinsp;=\\u0026thinsp;5), transposition of the great artery (n\\u0026thinsp;=\\u0026thinsp;3), idiopathic pulmonary artery hypertension (n\\u0026thinsp;=\\u0026thinsp;2), double outlet right ventricle (n\\u0026thinsp;=\\u0026thinsp;1), and pulmonary atresia with intact ventricular septum (n\\u0026thinsp;=\\u0026thinsp;1). Thirteen volunteers (21\\u0026ndash;26 years old) who underwent CMR examination at were included. The healthy subjects underwent echocardiography in advance to confirm that there were no problems with the intracardiac structural abnormalities or cardiac function. This study was conducted in compliance with the standards of the Declaration of Helsinki and the current ethical guidelines and was approved by our institutional ethics board (no. 21163). Written informed consent was obtained from all participants.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eAll cardiac imaging examinations were performed using MAGNETOM Vida (Siemens Healthcare, Erlangen, Germany) with a 3.0 Tesla MR system. The modified Look-Locker inversion recovery (MOLLI) sequence with motion correction was used for T1 mapping. The images required for T1 mapping were taken in one-six cardiac short-axis slices (basal, mid, and apex). T1 mapping was performed under breath-holding conditions in all patients. The other scan parameters were as follows: field of view, 360\\u0026times;360 mm; slice thickness, 8 mm; flip angle, 35\\u0026deg;; matrix size, 256\\u0026times;144; base resolution, 256; phase resolution, 144 (66%); reduce field of view, 85.2%; pixel size, 1.4\\u0026times;1.4\\u0026times;8.0mm\\u003csup\\u003e3\\u003c/sup\\u003e; acceleration factor, 2; echo time, 1.06 msec, repetition time, 2.53 msec; and shot mode, true fast imaging with steady-state precession pulse sequence using the 5b(3b)3b scheme. A workstation (Cvi42, Circle, Cardiovascular Imaging, Calgary, Canada) was used for analysis.\\u003c/p\\u003e \\u003cp\\u003eWe cannot take systolic T1 mapping due to initial MRI settings. So, in our study, systolic T1 mapping was performed using the following method (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). We calculated the time difference between the setting time on the device side when capturing the diastolic T1 mapping and the capture time of the completed diastolic T1 mapping images. This difference is the time required for the T1 mapping process. By subtracting this time difference from the systolic imaging time of the cine MRI image, it became possible to determine the setting time of the systolic T1 mapping on the device side, and the systolic T1 mapping images became possible. When we obtained the setting time and imaging time on the device side of the diastolic T1 mapping of 22 participants who had been studied, the setting time on the device side was 236.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;132.4 msec, the shooting time was 421.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;132.6 msec, and the time difference was found to be 184.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.84 msec. Therefore, the setting time on the device side for systolic T1 mapping was calculated by subtracting 185 msec from the systolic imaging time of cine MRI to enable the systolic T1 mapping images. We confirmed visually that the systolic T1 mapping images taken as described above were in the systolic phase.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eAll parameters are expressed as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation. Statistical differences were determined using the Mann\\u0026ndash;Whitney U and Wilcoxon signed-rank. Statistical significance was set at P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. Statistical calculations were performed using Statistical Package for the Social Sciences (version 28.0; IBM Corp., Armonk, NY, USA).\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe characteristics of participants in this study are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. We investigated whether the myocardial T1 value changed because of the difference in the cardiac cycle using the left ventricular myocardial T1 value (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;4). The diastolic myocardial T1 value of the ventricular septal wall in the 13 healthy subjects was 1216.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;40.5 msec, and the systolic myocardial T1 value was 1214.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;27.1 msec, showing no significant difference (p\\u0026thinsp;=\\u0026thinsp;0.754) (Fig.\\u0026nbsp;4). In addition, the diastolic myocardial T1 value of the lateral wall of the left ventricle was 1161.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;49.9 msec, and the systolic myocardial T1 value was 1167.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;37.1 msec, neither of which was significantly different (p\\u0026thinsp;=\\u0026thinsp;0.447) (Fig.\\u0026nbsp;4). We found that myocardial T1 values did not change significantly during the cardiac cycle. Myocardial T1 values in the lateral wall of the left ventricle were significantly lower than those in the septal wall, both diastolic and systolic phase (diastole, p\\u0026thinsp;=\\u0026thinsp;0.003; systole, p\\u0026thinsp;=\\u0026thinsp;0.002). There was no difference in left ventricular T1 values by cardiac cycle in the patient group, nor was there a significant difference in left ventricular T1 values compared to the healthy subjects (Fig.\\u0026nbsp;4).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDemographic and T1 mapping data\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVolunteers\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;13)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePatients\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;12)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex (male : female)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11 : 2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8 : 4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.378\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.052\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHeight (cm)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e167.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e162.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.347\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBody weight (kg)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e52.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.347\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHeart rate (bpm)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e70.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e80.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.030\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiastolic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLV septal T1 values (msec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1216.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;40.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1238\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;41.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.247\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLV lateral T1 values (msec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1161.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;49.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1120\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;41.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.152\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRV T1 values (msec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1347.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;86.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1346.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;96.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.852\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSystolic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLV septal T1 values (msec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1214.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;27.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1238.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.247\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLV lateral T1 values (msec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1167.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;37.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1199.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;29.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.077\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRV T1 values (msec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1233.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;58.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1312.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;34.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.002\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eLV; left ventricular, RV; right ventricular.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eNormal systolic right ventricular myocardial T1 values were measured using systolic right ventricular T1 mapping in the healthy subjects and Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e shows T1 mapping images of the healthy subject and patient group. The right ventricular myocardial T1 value was determined by setting ROIs in areas where the myocardium of the right ventricular free- and inferior walls is sufficiently thick to avoid the effects of blood. As a result, the normal systolic right ventricular free- and inferior walls myocardial T1 values were 1234.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;42.4 msec and 1235.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;36.7 msec, respectively (p\\u0026thinsp;=\\u0026thinsp;0.795). Hence, normal right ventricular myocardium did not differ in systolic T1 values depending on the site of measurement. On the other hand, in the diastolic phase, the right ventricular myocardial T1 value in the healthy subject was 1347.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;86.5 msec, and the right ventricular myocardial T1 value in the right ventricular overloaded group was 1346.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;96.7 msec, which was no difference (p\\u0026thinsp;=\\u0026thinsp;0.852, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). In the systolic phase, the right ventricular myocardial T1 value in the healthy subject was 1233.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;58.9 msec, and the right ventricular myocardial T1 value in the right ventricular overloaded group was 1312.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;34.5 msec, which was significant difference (p\\u0026thinsp;=\\u0026thinsp;0.002, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, we found that systolic T1 mapping could be obtained from diastolic T1 mapping and cine MRI images, there was little change in myocardial T1 value due to the cardiac cycle, and the systolic right ventricular myocardial T1 value was high in patients with right ventricular overload.\\u003c/p\\u003e \\u003cp\\u003eUnder standard settings, the cardiac cycle is determined from the QRS complex, and T1 mapping is performed during diastole [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Therefore, systolic imaging should be devised, as in this study. Our results suggest almost no difference in T1 mapping processing time between individuals, and systolic T1 mapping was possible by subtracting 185 msec from the systolic time of the cine MRI images. It is necessary to examine whether this value of 185 msec remains the same for other MRI devices in the future. Once the processing time for T1 mapping is obtained at one's facility, systolic T1 mapping can always be obtained from cine MRI images, which is very useful. When setting the systolic time, Ursula et al. examined systolic T1 mapping by shifting a certain amount of time from diastole [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. In that method, changes in heart rate cause a shift in systolic timing. Therefore, our method is better at setting systolic timing independent of heart rate.\\u003c/p\\u003e \\u003cp\\u003eIn addition, we found that the myocardial T1 value hardly changed during the cardiac cycle. Carlo et al. reported no difference in left ventricular myocardial T1 values between diastole and systole [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. In contrast, Ursula et al. reported that the myocardial T1 value significantly decreased during systole than during diastole, but the difference was approximately 2.5%, which is unlikely to be clinically significant [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. The slight change in myocardial T1 value with the cardiac cycle indicates no problem in evaluating the right ventricular myocardial T1 value in either the diastolic or systolic cardiac cycle. In determining the normal right ventricular myocardial T1 value, it is difficult to measure the diastolic right ventricular myocardial T1 value in healthy subjects. Because the right ventricular myocardium has a thin myocardial wall and rough endocardial surface, the myocardium is insufficiently thick to surround the myocardial ROI and is susceptible to blood-induced T1 elevation. Because the myocardial wall is thicker during systole than diastole, the free and inferior walls of the right ventricle increase the number of sites where the ROI can be obtained. Despite this, the measurement locations are often limited. When considering setting normal values, it is important to take multiple cross sections to increase the number of measurable locations as we did.\\u003c/p\\u003e \\u003cp\\u003eRegarding the site of myocardial T1 measurement, our results showed a significant difference between the left ventricular septal and posterior walls, consistent with a previous report [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The myocardial T1 value of the left ventricular posterior wall is known to be lower than that of the septal wall owing to the effects of cardiac motion [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Similar results were expected for the right ventricular myocardium. However, there was no significant difference in myocardial T1 values between the right ventricular free and inferior walls during systole in healthy subjects. Therefore, if it is difficult to obtain the myocardial T1 value on the free wall, there is no significant problem in evaluating the myocardial T1 value on the inferior wall. It is desirable to evaluate the same location over time.\\u003c/p\\u003e \\u003cp\\u003eConsistent with previous reports, patients with right ventricular myocardial injury had elevated right ventricular myocardial T1 values [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The right ventricular myocardial T1 value is known to be elevated in patients with pulmonary hypertension and after surgery for tetralogy of Fallot. But, in previous reports, the right ventricular myocardial T1 value was evaluated during diastole [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The validity of the diastolic right ventricular myocardial T1 value has been cited as a limitation in all the previous reports. Among patients with right ventricular overload, especially those with right ventricular pressure overload, the thickness of the right ventricular myocardium is sufficient even during diastole due to right ventricular hypertrophy. Therefore, measurement of the myocardial T1 value is almost unaffected by blood and can be measured accurately. As mentioned earlier, it is challenging to measure the normal T1 value in diastolic right ventricular myocardium. Without knowing normal values, it is not possible to evaluate right ventricular T1 values in disease groups. Even in patients with a thick right ventricular myocardium, it is possible to compare with normal values by imaging systolic T1 mapping and quantitative evaluation of right ventricular myocardial damage can now be performed.\\u003c/p\\u003e \\u003cp\\u003eOne of the limitations of this study is the small number of cases. In particular, there are limited data on healthy subjects. Since myocardial T1 changes are known to depend on sex and age, it is necessary to increase the number of cases in the future and determine the normal value of right ventricular myocardial T1 during systole. Also, due to the small number of cases, we were unable to separate patient groups into pressure or volume overload. It is necessary to study with a large number of patients in the future. Second, it is difficult to measure the right ventricular myocardial T1 value. The right ventricular myocardium of healthy subjects was measured as a normal myocardium at any site. There might be a difference depending on the site in the patient group. To ensure sufficient thickness of the right ventricular myocardium, even during systole, it is considered appropriate to evaluate systolic T1 mapping only in patients with right ventricular overload, and further investigation is required.\\u003c/p\\u003e \\u003cp\\u003eWe quantitatively evaluated the properties of the right ventricular myocardium by right ventricular myocardial T1 mapping during systole. The right ventricular myocardial T1 value can be evaluated by measuring it during systole rather than diastole and can be useful for evaluating myocardial damage.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eDisclosures\\u003c/h2\\u003e \\u003cp\\u003eThe authors have no conflicts of interest to disclose.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eThis research did not receive specific grants from any funding agency, or commercial or non-profit entities.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eY.S. and H.O. conceptualized and designed the study, drafted the initial manuscript, carried out the initial analyses, and critically reviewed and revised the manuscript.Y.S. and K.I. and R.I. and S.S. and Y.A. and K.F. and S.N. and K.I. designed the data collection instruments, collected data, and critically reviewed and revised the manuscript.K.N. and S.T. designed the data collection instruments, coordinated and supervised data collection, and critically reviewed and revised the manuscript.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgment\\u003c/h2\\u003e \\u003cp\\u003eWe would like to thank Editage (\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e\\u003ca href=\\\"http://www.editage.com\\\" target=\\\"_blank\\\"\\u003ewww.editage.com\\u003c/a\\u003e\\u003c/span\\u003e\\u003cspan address=\\\"http://www.editage.com\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e) for English language editing.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eStout KK, Daniels CJ, Aboulhosn JA et al (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 139:698\\u0026ndash;800\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYumi S, Tomohiro T, Yasutaka K (2011) eta l Prevalence of adult patients with congenital heart disease in Japan. Int J Cardiol 146:13\\u0026ndash;16\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHideo O, Masaaki K, Hideki U, Teiji A, Atsushi Y, Hideaki S et al (2022) JCS 2022 guideline on management and re-interventional therapy in patients. Congenital heart disease long-term after initial repair. Circ J 86:1591\\u0026ndash;1690\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKellman P, Hansen MS (2014) T1-mapping in the heart: Accuracy and precision. J Cardiovasc Magn Reson 16:2\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMewton N, Liu CY, Croisille P et al (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891\\u0026ndash;903\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMessroghli DR, Moon JC, Ferreira VM et al (2017) Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson 19:75\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePiechnik SK, Ferreira VM, Lewandowski AJ et al (2013) Normal variation of magnetic resonance T1 relaxation times in the human population at 1.5 T using ShMOLLI. J Cardiovasc Magn Reson 15:13\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRauhalammi SMO, Mangion K, Barrientos PH et al (2016) Native myocardial longitudinal (T1) relaxation time: regional, age, and sex associations in the healthy adult heart. J Magn Reson Imagin 44:541\\u0026ndash;548\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTaylor AJ, Salerno M, Dharmakumar R et al (2016) T1 mapping: Basic techniques and clinical applications. JACC Cardiovasc Imaging 9:67\\u0026ndash;81\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBiglands JD, Radjenovic A, Ridgway JP (2012) Cardiovascular magnetic resonance physics for clinicians: part II. J Cardiovasc Magn Reson 14:66\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eReiter U, Reiter G, Dorr K et al (2014) Normal diastolic and systolic myocardial T1 values at 1.5-T MR imaging: correlations and blood normalization. Radiology 271:365\\u0026ndash;372\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTessa C, Diciotti S, Landini N et al (2015) Myocardial T1 and T2 mapping in diastolic and systolic phase. Int J Cardiovasc Imag 31:1001\\u0026ndash;1010\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eShiina Y, Taniguchi K, Nagao M et al (2020) The relationship between extracellular volume fraction in symptomatic adults with tetralogy of Fallot adverse cardiac events. J Cardiol 75:424\\u0026ndash;431\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAsano R, Ogo T, Morita Y et al (2021) Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertention. PLoS ONE 16\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"T1 mapping, systolic phase, right ventricular myocardium, right ventricular overload, cardiac MRI.\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3860686/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3860686/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e Myocardial properties can be quantitatively evaluated using myocardial T1 values obtained using cardiac magnetic resonance imaging. In terms of myocardial wall thickness, the left ventricular T1 value is easy to measure, but the right ventricular T1 value is difficult. Patients with congenital heart disease often develop right ventricular overload. We aimed to determine whether T1 mapping during systole can be used to evaluate right ventricular myocardial properties.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e T1 mapping was performed at diastole and systole, and the myocardial properties of both ventricles were evaluated in 13 healthy participants (21–26 years old) and 12 patients with right ventricular overload (12–41 years old) who underwent cardiac magnetic resonance imagingexamination at our hospital.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e From analysis of left ventricular myocardial T1 values, we found that myocardial T1 values did not change significantly during the cardiac cycle. But, right ventricular T1 values changed between diastole and systole because the right ventricle is affected by blood. Although there was no difference in right ventricular diastolic myocardial T1 values between the patients and volunteers (1346.8 vs. 1347.6 msec, p=0.852), the right ventricular systolic myocardial T1 values was significantly higher in patients than in volunteers (1312.7 vs. 1233.8 msec, p=0.002).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003c/strong\\u003e Systolic right ventricular myocardial T1 mapping allows assessment of right ventricular myocardial properties. The right ventricular myocardial systolic T1 value is useful for evaluating myocardial damage due to right ventricular stress and myocardial injury.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Evaluation of right ventricular myocardial properties using systolic myocardial T1 mapping\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-01-17 17:11:22\",\"doi\":\"10.21203/rs.3.rs-3860686/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"6728ea80-c30d-4449-abb6-121ba0174fe3\",\"owner\":[],\"postedDate\":\"January 17th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-01-17T17:11:25+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-01-17 17:11:22\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3860686\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3860686\",\"identity\":\"rs-3860686\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}