Assessment of cardiac involvement in myotonic muscular dystrophy by T1 mapping on magnetic resonance imaging

BackgroundPatients with myotonic muscular dystrophy (DM) are at risk for atrioventricular block and left ventricular (LV) dysfunction. Noninvasive detection of diffuse myocardial fibrosis may improve disease management in this population.ObjectiveTo define functional and postcontrast myocardial T1 time cardiac magnetic resonance characteristics in patients with DM.MethodsThirty-three patients with DM (24 with type 1 and 9 with type 2) and 13 healthy volunteers underwent cardiac magnetic resonance for the assessment of LV indices and the evaluation of diffuse myocardial fibrosis by T1 mapping. The association of myocardial T1 time with electrocardiogram abnormalities and LV indices was examined among patients with DM.ResultsPatients with DM had lower end-diastolic volume index (68.9 mL/m2 vs 60.3 mL/m2; P = .045) and cardiac index (2.7 L/min/m2 vs 2.33 L/min/m2; P = .005) and shorter myocardial T1 time (394.5 ms vs 441.4 ms; P < .0001) than did control subjects. Among patients with DM, there was a positive association between higher T1 time and LV mass index (2.2 ms longer per g/m2; P = .006), LV end-diastolic volume index (1.3 ms longer per mL/m2; P = .026), filtered QRS duration (1.2 ms longer per unit; P = .005), and low-amplitude (<40 mcV) late-potential duration (0.9 ms longer per unit; P = .01). Using multivariate random effects regression, each 10-ms increase in myocardial T1 time of patients with type 1 DM was independently associated with 1.3-ms increase in longitudinal PR and QRS intervals during follow-up.ConclusionsDM is associated with structural alterations on cardiac magnetic resonance. Postcontrast myocardial T1 time was shorter in patients with DM than in controls, likely reflecting the presence of diffuse myocardial fibrosis.