Myocardial Native T1 Mapping in the German National Cohort (NAKO): Associations with Age, Sex, and Cardiometabolic Risk Factors
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Background and Aims
In cardiovascular magnetic resonance (CMR), myocardial native T1 mapping enables quantitative, non-invasive tissue characterization and is sensitive to subclinical changes in myocardial structure and composition. We investigated how age, sex, and cardiometabolic risk factors are associated with myocardial T1 in a population-based analysis within the German National Cohort (NAKO).
Methods
This cross-sectional study included 29,573 prospectively enrolled participants who underwent CMR-based midventricular T1 mapping at 3.0 T, alongside clinical phenotyping. After artificial intelligence-assisted myocardial segmentation, a subset of 9,162 outliers was subjected to manual quality control according to clinical evaluation standards. Associations with cardiometabolic risk factors, identified through self-reported medical history, clinical chemistry, and blood pressure measurements, were evaluated using adjusted linear regression models.
Results
Women had higher T1 values than men, with sex differences progressively declining with age. T1 was significantly elevated in individuals with diabetes (β=3.91 ms; p<0.001), kidney disease (β=3.44 ms; p<0.001), and current smoking (β=6.67 ms; p<0.001). Conversely, hyperlipidaemia was significantly associated with lower T1 (β=−4.41 ms; p<0.001). Associations with hypertension showed a sex-specific pattern: T1 was lower in women but increased with hypertension severity in men.
Conclusions
Myocardial native T1 varies by sex and age and shows associations with major cardiometabolic risk factors. Notably, lower T1 times in participants with hyperlipidaemia may indicate a direct effect of blood lipids on the heart. Our findings support the utility of T1 mapping as a sensitive marker of early myocardial changes and highlight the sex-specific interplay between cardiometabolic health and myocardial tissue composition.
Graphical Abstract
Key Question
How are age, sex, and cardiometabolic risk factors associated with myocardial native T1, a quantitative magnetic resonance imaging marker of myocardial tissue composition, in a large-scale population-based evaluation within the German National Cohort (NAKO)?
Key Finding
T1 relaxation times were higher in women and gradually converged between sexes with age. Diabetes, kidney disease, smoking, and hypertension in men were associated with prolonged T1 times. Unexpectedly, hyperlipidaemia and hypertension in women showed a negative association with T1.
Take-Home Message
Native T1 mapping is sensitive to subclinical myocardial changes and reflects a close interplay between metabolic and myocardial health. It reveals marked age-dependent sex differences and sex-specific responses in myocardial tissue composition to cardiometabolic risk factors.
