Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of elevated left ventricular end diastolic pressure in patients with preserved ejection fraction using cardiac magnetic resonance

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study aims to validate the reliability of cardiac magnetic resonance (CMR) parameters for estimating left ventricular end diastolic pressure (LVEDP) in heart failure patients with preserved ejection fraction (HFpEF) and compare their accuracy to conventional echocardiographic ones, with reference to left heart catheterisation.

Methods

Sixty patients with exertional dyspnoea (New York Heart Association function class II to III) were consecutively enrolled. CMR-derived time-volume curve and deformation parameters, conventional echocardiographic diastolic indices as well as LVEDP evaluated by left heart catheterisation were collected and analysed.

Results

Fifty-one patients, who accomplished all three examinations, were divided into HFpEF group and non-HFpEF group based on LVEDP measurements. Compared to the non-HFpEF group, CMR-derived time-volume curve showed lower peak filling rate adjusted for end diastolic volume (PFR/EDV, p = 0.027), longer time to peak filling rate (T-PFR, p < 0.001), and increased T-PFR in one cardiac cycle (%T-PFR, p < 0.001) in HFpEF group. In multivariable linear regression analysis, %T-PFR (β = 0.372, p = 0.024), left ventricular global peak longitudinal diastolic strain rate (LDSR, β = −0.471, p = 0.006), and E/e’ (β = 0.547, p = 0.001) were independently associated with invasively measured LVEDP. The sensitivity and specificity of E/e’ and LDSR for predicting the elevated LVEDP were 76%, 92% and 76%, 89%, respectively.

Conclusions

These findings suggest that CMR-derived time-volume curve and strain indices could predict HFpEF patients. Not only E/e’ assessed by echocardiography but also the CMR-derived %T-PFR and LDSR correlated well with LVEDP. These non-invasive parameters were validated to evaluate the left ventricular diastolic function.

Key Points

• The abnormal time-volume curve revealed insufficient early diastole in HFpEF patients.

• Non-invasive parameters including E/e’, %T-PFR, and LDSR correlated well with LVEDP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

%T-PFR:

Time to peak filling rate in one cardiac cycle

ASE:

American Society of Echocardiography

BMI:

Body mass index

BNP:

Brain natriuretic peptide

BSA:

Body surface area

CDSR:

Left ventricular global peak circumferential diastolic strain rate

CMR:

Cardiac magnetic resonance

EDV:

End diastolic volume

EGFR:

Estimated glomerular filtration rate

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

ICC:

Intraclass correlation coefficient

LAVI:

BSA-indexed left atrial volume

LDSR:

Left ventricular global peak longitudinal diastolic strain rate

LV:

Left ventricular

LVEDP:

Left ventricular end diastolic pressure

LVEDVI:

BSA-indexed LV end diastolic volume

LVEF:

Left ventricular ejection fraction

LVESVI:

BSA-indexed LV end-systolic volume

LVMI:

BSA-indexed LV mass

PFR:

Peak filling rate

PFR/EDV:

Peak filling rate adjusted for end diastolic volume

PFV:

Peak filling volume

RDSR:

Left ventricular global peak radial diastolic strain rate

T-PFR:

Time to peak filling rate

TDI:

Tissue Doppler imaging

References

  1. Aziz F, Thazhatauveetil-Kunhahamed LA, Enweluzo C, Zaeem M (2013) Heart failure with preserved EF: a bird eye view. JNMA J Nepal Med Assoc 52:405–412. https://doi.org/10.5888/pcd10.120203

    Article  PubMed  Google Scholar 

  2. Borlaug BA, Paulus WJ (2011) Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 32:670–679. https://doi.org/10.1093/eurheartj/ehq426

    Article  PubMed  Google Scholar 

  3. Steinberg BA, Zhao X, Heidenreich PA et al (2012) Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 126:65–75. https://doi.org/10.1161/CIRCULATIONAHA.111.080770

    Article  PubMed  Google Scholar 

  4. Paulus WJ, Tschöpe C, Sanderson JE et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28:2539–2550. https://doi.org/10.1093/eurheartj/ehm037

    Article  PubMed  Google Scholar 

  5. von Knobelsdorff-Brenkenhoff F, Pilz G, Schulz-Menger J (2017) Representation of cardiovascular magnetic resonance in the AHA/ACC guidelines. J Cardiovasc Magn Reson 19:70. https://doi.org/10.1186/s12968-017-0385-z

    Article  Google Scholar 

  6. Mendoza DD, Codella NC, Wang Y et al (2010) Impact of diastolic dysfunction severity on global left ventricular volumetric filling-assessment by automated segmentation of routine cine cardiovascular magnetic resonance. J Cardiovasc Magn Reson 12:46. https://doi.org/10.1186/1532-429X-12-46

    Article  PubMed  PubMed Central  Google Scholar 

  7. Göransson C, Vejlstrup N, Carlsen J (2018) Reproducibility of peak filling and peak emptying rate determined by cardiovascular magnetic resonance imaging for assessment of biventricular systolic and diastolic dysfunction in patients with pulmonary arterial hypertension. Int J Cardiovasc Imaging 34:777–786. https://doi.org/10.1007/s10554-017-1281-1

    Article  PubMed  Google Scholar 

  8. Tao YJ, Gao CJ, Wu H et al (2017) Application of cardiac magnetic resonance cine imaging in diagnosis and treatment of heart failure with preserved ejection fraction. Acad J Second Mil Med Uni 38:1273–1278. https://doi.org/10.16781/j.0258-879x.2017.10.1273

    Article  Google Scholar 

  9. Kuetting D, Sprinkart AM, Doemer J, Schild H, Thomas D (2015) Comparison of magnetic resonance feature trackking with harmonic phase imaging analysis (CSPAMM) for assessment of global and regional diastolic function. Eur J Radiol 84:100–107. https://doi.org/10.1016/j.ejrad.2014.10.011

    Article  CAS  PubMed  Google Scholar 

  10. Patel D, Robinson VJ, Arteaga RB, Thornton JW (2008) Diastolic filling parameters derived from myocardial perfusion imaging can predict left ventricular end-diastolic pressure at subsequent cardiac catheterization. J Nucl Med 49:746–751. https://doi.org/10.2967/jnumed.107.049395

    Article  PubMed  Google Scholar 

  11. ASCI CCT and CMR Guideline Working Group, Chan CW, Choi BW et al (2010) ASCI 2010 standardized practice protocol for cardiac magnetic resonance imaging: a report of the Asian society of cardiovascular imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group. Int J Cardiovasc Imaging 26:187–202. https://doi.org/10.1007/s10554-009-9577-4

    Article  PubMed Central  Google Scholar 

  12. Westenberg JJM (2011) CMR for assessment of diastolic function. Curr Cardiovasc Imaging Rep 4:149–158. https://doi.org/10.1007/s12410-011-9070-z

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hieda M, Parker J, Rajabi T et al (2018) Left ventricular volume-time relation in patients with heart failure with preserved ejection fraction. Am J Cardiol 121:609–614. https://doi.org/10.1016/j.amjcard.2017.11.033

    Article  PubMed  Google Scholar 

  14. Sharifov OF, Schiros CG, Aban I, Denney TS, Gupta H (2016) Diagnostic accuracy of tissue doppler index E/e’ for evaluating left ventricular filling pressure and diastolic dysfunction/ heart failure with preserved ejection fraction: a systematic review and meta-analysis. J Am Heart Assoc 25:5. https://doi.org/10.1161/JAHA.115.002530

    Article  Google Scholar 

  15. Lancellotti P, Galderisi M, Edvardsen T et al (2017) Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI euro-filling study. Eur Heart J Cardiovasc Imaging 18:961–968. https://doi.org/10.1093/ehjci/jex067

    Article  PubMed  Google Scholar 

  16. Andersen OS, Smiseth OA, Dokainish H et al (2017) Estimating left ventricular filling pressure by echocardiography. J Am Coll Cardiol 69:1937–1948. https://doi.org/10.1016/j.jacc.2017.01.058

    Article  PubMed  Google Scholar 

  17. Watanabe T, Iwai-Takano M, Oikawa M, Yamaki T, Yaoita H, Maruyama Y (2008) Optimal noninvasive assessment of diastolic heart failure in patients with atrial fibrillation: comparison of tissue Doppler echocardiography, left atrium size, and brain natriuretic peptide. J Am Soc Echocardiogr 21:689–696. https://doi.org/10.1016/j.echo.2007.08.014

    Article  PubMed  Google Scholar 

  18. Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol 53:1119–1126. https://doi.org/10.1016/j.jacc.2008.11.051

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wang J, Khoury DS, Thohan V, Torre-Amione G, Nagueh SH (2007) Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation 115:1376–1383. https://doi.org/10.1161/CIRCULATIONAHA.106.662882

  20. Morris DA, Takeuchi M, Nakatani S et al (2018) Lower limit of normality and clinical relevance of left ventricular early diastolic strain rate for the detection of left ventricular diastolic dysfunction. Eur Heart J Cardiovasc Imaging 19:905–915. https://doi.org/10.1093/ehjci/jex185

    Article  PubMed  Google Scholar 

Download references

Funding

This study has received funding by Grant No. LYZY-0193 (study the parameters to identify different prognosis of patients with non-ischemia cardiomyopathy.) from the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital.

Author information

Authors and Affiliations

  1. Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Chengjie Gao

  2. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Yijing Tao, Jingwei Pan, Chengxing Shen, Zhili Xia, Qing Wan, Hao Wu, Yajie Gao, Hong Shen, Zhigang Lu & Meng Wei

  3. Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Jiayin Zhang

Authors
  1. Chengjie Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yijing Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jingwei Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chengxing Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jiayin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhili Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qing Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yajie Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hong Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhigang Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Meng Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jingwei Pan or Chengxing Shen.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Jingwei Pan.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• perspective

• observational

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Chengjie Gao and Yijing Tao are regarded as co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gao, C., Tao, Y., Pan, J. et al. Evaluation of elevated left ventricular end diastolic pressure in patients with preserved ejection fraction using cardiac magnetic resonance. Eur Radiol 29, 2360–2368 (2019). https://doi.org/10.1007/s00330-018-5955-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5955-4

Keywords

Search

Navigation