Myocardial native T1 mapping in the German National Cohort (NAKO): associations with age, sex, and cardiometabolic risk factors

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Item Type:	Preprint
Title:	Myocardial native T1 mapping in the German National Cohort (NAKO): associations with age, sex, and cardiometabolic risk factors
Creators Name:	Ammann, Clemens, Gröschel, Jan, Saad, Hadil, Rospleszcz, Susanne, Schuppert, Christopher, Hadler, Thomas, Hickstein, Richard, Niendorf, Thoralf, Nolde, Janis M., Schulze, Matthias B., Greiser, Karin H., Decker, Josua A., Kröncke, Thomas, Küstner, Thomas, Nikolaou, Konstantin, Willich, Stefan N., Keil, Thomas, Dörr, Marcus, Bülow, Robin, Bamberg, Fabian, Pischon, Tobias, Schlett, Christopher L. and Schulz-Menger, Jeanette
Abstract:	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.
Keywords:	German National Cohort (NAKO), T1 Mapping, Cardiovascular Magnetic Resonance, Myocardium, Cardiometabolic, Cardiovascular Disease
Source:	medRxiv
Publisher:	Cold Spring Harbor Laboratory Press
Article Number:	2025.07.16.25331651
Date:	17 July 2025
Official Publication:	https://doi.org/10.1101/2025.07.16.25331651

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