ESC Congress 2026 Abstract · Oct 26, 2026
Age and sex specific normal reference values for 3T spin echo cardiac diffusion tensor imaging in 104 healthy subjects
By Asad M, Lwin M, Borg L et al.
Purpose: Myocardial ageing is a complex non-linear process which can manifest across all aspects of the cardiovascular system. In the myocardium, ageing can lead to distinct remodelling patterns and contractile dysfunction through sarcomeric alterations, interstitial fibrosis and mitochondrial dysfunction which, collaboratively promote cellular senescence1. It is not yet fully understood how the heart’s microstructure is implicated in this ageing process. Cardiac microstructure assessment with cardiac diffusion tensor imaging (cDTI) can provide a window into this process2. We report on age-specific reference normal ranges for myocardial microstructure in a large healthy population using cardiac diffusion tensor imaging (cDTI). Methods: In this single centre study, 104 healthy adult subjects (mean age 50 years, range 20-87 years, with 52 female participants) underwent free breathing, motion compensated (M2) single shot spin echo (SE) cDTI on a Siemens Prisma 3T scanner as previously reported3. Groups were divided into deciles according to age and sex. Results: All participants had normal cardiac function (Table 1). In line with published findings, the participants demonstrated significantly smaller LV volumes with increasing age. Significant correlations were found between age and LVEDVi (R=-0.348 p=0.001), LVESVi (R=-0.298, p=0.006) and LVMi (R=-0.350, p=0.003). There was a significant and progressive increase in global mean diffusivity (MD) and secondary eigenvector angle (E2A) (p=0.006 and p=0.001, respectively) with a significant decrease in global fractional anisotropy (FA) (p=0.001) with increasing age. There was no significant difference in helix angle gradient (HAg) with increasing age (p=0.101). Using post hoc analysis, FA showed significant decrease beyond the age of 40, while E2A depicted a significant change from the age of 50 (Table 2). There were significant correlations between all cDTI parameters and age (MD; R=0.276, p=0.006, FA; R=-0.495, p=0.001, E2A; R=0.485, p=0.001 and HAg; R=0.258, p=0.013). Multivariate analysis showed that age was independently associated with global E2A and HAg. Global MD, FA and E2A were statistically significant between sexes (p=0.048, p=0.001 and p=0.016, respectively). Conclusion: The assessment of myocardial microstructure with cDTI parameters, shows a significant difference between age deciles for global MD, FA and E2A in healthy individuals. This suggests changes in the myocardial microstructure in the ageing heart. We also demonstrate sex-specific differences within these parameters. These age and sex specific differences need to be considered when interpreting cDTI studies.Demographics TableGlobal cDTI parameters