Association of Myocardial T1/T2 Mapping Abnormalities With Late Gadolinium Enhancement and Left Ventricular Function

INTRODUCTION: To investigate the relationship between visually assessed myocardial late gadolinium enhancement (LGE), native T1/T2 mapping abnormalities, and left ventricular ejection fraction (LVEF) in a real-world adult cardiovascular magnetic resonance (CMR) cohort. METHODS: This retrospective study included consecutive adults referred for clinical CMR with evaluable LGE. LGE presence (yes/no) was used as the comparative reference. Mapping abnormality was defined as elevated native T1 and/or T2 values using protocol-specific institutional reference limits derived from healthy controls (non-parametric upper reference limit; 95th percentile). Associations between LGE, mapping findings, and LVEF were assessed using univariable and multivariable logistic regression adjusted for age and LVEF. RESULTS: A total of 1074 consecutive adult patients undergoing clinical CMR were screened. After predefined exclusions, 1005 patients in whom both late gadolinium enhancement and myocardial T1/T2 mapping were evaluable constituted the final analysis set. Myocardial LGE was present in 54.5%. Mapping abnormalities were strongly associated with LGE positivity (OR 8.61; 95% CI 6.05–12.26; p<0.001) and remained independently associated after multivariable adjustment for age and LVEF (adjusted OR 7.73; 95% CI 5.38–11.10; p<0.001). LGE-positive patients had lower LVEF than LGE-negative patients, and mapping abnormalities were also associated with lower LVEF. The mapping–LGE association persisted in both preserved and reduced LVEF strata. DISCUSSION AND CONCLUSION: In a large heterogeneous adult CMR population, T1/T2 mapping abnormalities show a strong and independent association with visually assessed LGE and ventricular function, supporting mapping as a complementary component of integrated myocardial tissue characterization.