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| Home > Publications database > Myocardial Native T1 Mapping in the German National Cohort (NAKO): Associations with Age, Sex, and Cardiometabolic Risk Factors. |
| Home > Publications database > Myocardial Native T1 Mapping in the German National Cohort (NAKO): Associations with Age, Sex, and Cardiometabolic Risk Factors. |
| Journal Article | DKFZ-2026-01850 |
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2026
Elsevier
[Amsterdam]
Abstract: 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. However, data on the association between cardiometabolic risk and myocardial alterations are still limited. We therefore investigated how age, sex, and cardiometabolic risk factors are associated with myocardial T1 as a potential imaging marker of myocardial target-organ involvement in a population-based analysis within the German National Cohort (NAKO).This cross-sectional study included 29,573 prospectively enrolled participants who underwent midventricular T1 mapping using 3.0T CMR along with deep clinical phenotyping. After artificial intelligence-assisted myocardial segmentation, a subset of 9,162 outlier cases was subjected to manual quality control according to clinical evaluation standards. Cardiometabolic risk factors were identified through self-reported, physician-diagnosed medical history, clinical chemistry, and blood pressure measurements. Associations with myocardial T1 were evaluated using multiple linear regression models adjusted for age, sex, heart rate, imaging site, and comorbidities.After quality control, 27,794 participants (12,401 [44.6%] women; 20-75 years) were included. Mean T1 was overall higher in women (1,231 ± 33 ms) than in men (1,209 ± 34 ms), with differences progressively declining with age. The sex difference was confirmed in a healthy subcohort (n = 3,910), whilst age interaction was less pronounced. In adjusted analyses, T1 was significantly higher in individuals with diabetes, kidney disease, and current smoking. Conversely, hyperlipidaemia was significantly associated with lower T1. Associations with hypertension showed strongly sex-specific patterns: women had lower T1 values, while T1 increased with hypertension severity in men.Myocardial native T1 varies by sex and age and shows distinct sex-specific associations with major cardiometabolic risk factors, supporting its role as a sensitive imaging marker of subtle myocardial alterations. Unexpectedly lower T1 times in participants with hyperlipidaemia suggest a potential direct effect of blood lipids on the heart, which warrants further investigation.
Keyword(s): German National Cohort (NAKO) ; T(1) mapping ; cardiometabolic ; cardiovascular disease ; cardiovascular magnetic resonance ; myocardium
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