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Characterisation of the cardiac interstitium using cardiovascular magnetic resonance

Sado, DM; (2014) Characterisation of the cardiac interstitium using cardiovascular magnetic resonance. Doctoral thesis , UCL (University College London).

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Abstract

In clinical cardiology, different imaging technologies can be used to assess cardiac anatomy, ventricular function and focal myocardial disease. Cardiovascular magnetic resonance (CMR) using late gadolinium enhancement (LGE) is the gold standard non-invasive method for focal myocardial tissue characterisation. However it has limitations, including not allowing quantification of the extracellular volume (ECV) or assessment of diffuse processes. In this thesis, these shortcomings were addressed using novel CMR T1 based methodologies. In early work, the ECV was assessed in health and a variety of cardiac diseases. It was found to be elevated in dilated and hypertrophic cardiomyopathy and aortic stenosis – diseases where diffuse fibrosis is known to occur. There was a more marked ECV elevation in cardiac AL amyloidosis. Further work assessed a potential role for pre contrast T1 in Anderson Fabry disease, finding that it detects disease at an earlier stage than any other imaging marker and is diagnostic of this disease in patients with left ventricular hypertrophy. In patients with iron overload, the T1 was found to strongly correlate with the previous non-invasive gold standard test of CMR T2*. However the T1 appeared to be more sensitive for the detection of earlier disease. Lastly, pilot technical development work evaluated new and faster methods for ECV and T1 assessment and suggested a potential role for this technique in other body organs. The above results were particularly notable in Anderson Fabry disease, iron overload and cardiac amyloidosis. In the case of Anderson Fabry disease and cardiac amyloidosis, sphingolipid and amyloid deposition respectively cannot be measured using current non-invasive clinical techniques. In conclusion, this work has pioneered the use of novel tissue characterisation techniques which have potential roles in earlier diagnosis, pathophysiological insights, prognostication and therapy monitoring in cardiac disease. This will ultimately provide benefit to patients with cardiac disease.

Type: Thesis (Doctoral)
Title: Characterisation of the cardiac interstitium using cardiovascular magnetic resonance
Language: English
Keywords: T1, cardiovascular magnetic resonance, extracellular volume
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: http://discovery.ucl.ac.uk/id/eprint/1420202
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