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ECV Mapping — EECC MCQ

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ModerateCardiac ImagingECV MappingEECC

A 55-year-old man with dilated cardiomyopathy (LVEF 30%) undergoes a cardiac MRI which shows mid-wall LGE and elevated native T1 values. The report describes an ECV (extracellular volume fraction) of 42% (normal <30%). What does the elevated ECV indicate?

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Correct answer: B — Diffuse myocardial fibrosis — elevated ECV reflects expansion of the extracellular space due to collagen deposition or infiltration, and is a strong independent predictor of adverse outcomes in cardiomyopathies

ECV (extracellular volume fraction) measured by cardiac MRI T1 mapping quantifies the relative proportion of extracellular space in the myocardium. Elevated ECV (>30%) indicates expansion of the extracellular matrix, most commonly due to diffuse myocardial fibrosis (collagen deposition) or infiltration (e.g. amyloidosis). In DCM, elevated ECV correlates with histological fibrosis and is a powerful independent predictor of all-cause mortality, HF hospitalisation, and arrhythmias — providing prognostic information beyond LVEF and even focal LGE. ECV is particularly valuable in conditions with diffuse fibrosis that may be missed by conventional LGE imaging. Very high ECV values (>40%) are characteristic of cardiac amyloidosis.

Reference: ESC (2023): Guidelines on Cardiomyopathies; SCMR/EACVI T1 Mapping Consensus