Myocardial T1-mapping and extracellular volume in pulmonary arterial hypertension: A systematic review and meta-analysis

Samer Alabed, Laura Saunders, Pankaj Garg, Yousef Shahin, Faisal Alandejani, Andreas Rolf, Valentina O. Puntmann, Eike Nagel, Jim M. Wild, David G. Kiely, Andrew J. Swift

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Introduction: Elevated myocardial T 1-mapping and extracellular volume (ECV) measured on cardiac MR (CMR) imaging is associated with myocardial abnormalities such as oedema or fibrosis. This meta-analysis aims to provide a summary of T 1-mapping and ECV values in pulmonary arterial hypertension (PAH) and compare their values with controls. Methods: We searched CENTRAL, MEDLINE, Embase, and Web of Science in August 2020. We included CMR studies reporting T 1-mapping or ECV values in adults with any type of PAH. We calculated the mean difference of T 1-values and ECV between PAH and controls. Results: We included 12 studies with 674 participants. T 1-values were significantly higher in PAH with the highest mean difference (MD) recorded at the RV insertion points (RVIP) (108 milliseconds (ms), 95% confidence intervals (CI) 89 to 128), followed by the RV free wall (MD 91 ms, 95% CI 56 to 126). The pooled mean T 1-value in PAH at the RVIP was 1084, 95% CI (1071 to 1097) measured using 1.5 Tesla Siemens systems. ECV was also higher in PAH with an MD of 7.5%, 95% CI (5.9 to 9.1) at the RV free wall. Conclusion: T 1 mapping values in PAH patients are on average 9% higher than healthy controls when assessed under the same conditions including the same MRI system, magnetic field strength or sequence used for acquisition. The highest T 1 and ECV values are at the RVIP. T 1 mapping and ECV values in PH are higher than the values reported in cardiomyopathies and were associated with poor RV function and RV dilatation.

Original languageEnglish
Pages (from-to)66-75
Number of pages10
JournalMagnetic Resonance Imaging
Early online date18 Mar 2021
Publication statusPublished - 1 Jun 2021


  • CMR
  • Cardiac MRI
  • Extracellular volume
  • Meta-analysis
  • Myocardial T mapping
  • Pulmonary hypertension

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