European Radiology

, Volume 29, Issue 3, pp 1555–1564 | Cite as

Diastolic dysfunction evaluated by cardiac magnetic resonance: the value of the combined assessment of atrial and ventricular function

  • Giovanni Donato AquaroEmail author
  • Fausto Pizzino
  • Anna Terrizzi
  • Scipione Carerj
  • Bijoy K. Khandheria
  • Gianluca Di Bella



We sought to evaluate the role of cardiac magnetic resonance imaging (CMR) in the evaluation of diastolic function by a combined assessment of left ventricular (LV) and left atrial (LA) function in a cohort of subjects with various degrees of diastolic dysfunction (DD) detected by echocardiography.


Forty patients with different stages of DD and 18 healthy controls underwent CMR. Short-axis cine steady-state free precession images covering the entire LA and LV were acquired. Parameters of diastolic function were measured by the analysis of the LV and LA volume/time (V/t) curves and the respective derivative dV/dt curves.


At receiver operating characteristic (ROC) curve analysis, the peak of emptying rate A indexed by the LV filling volume with a cut-off of 3.8 was able to detect patients with grade I DD from other groups (area under the curve [AUC] 0.975, 95% confidence interval [CI] 0.86–1). ROC analysis showed that LA ejection fraction with a cut-off of ≤36% was able to distinguish controls and grade I DD patients from those with grade II and grade III DD (AUC 0.996, 95% CI 0.92–1, p < 0.001). The isovolumetric pulmonary vein transit ratio with a cut-off of 2.4 allowed class III DD to be distinguished from other groups (AUC 1.0, 95%CI 0.93–1, p < 0.001).


Analysis of LV and LA V/t curves by CMR may be useful for the evaluation of DD.

Key Points

• Combined atrial and ventricular volume/time curves allow evaluation of diastolic function.

• Atrial emptying fraction allows distinction between impaired relaxation and restrictive/pseudo-normal filling.

• Isovolumetric pulmonary vein transit ratio allows distinction between restrictive and pseudo-normal filling.


Diastole Magnetic resonance Heart failure Physiology: atrial function Hypertrophic cardiomyopathy 



Cardiac magnetic resonance


Diastolic dysfunction


Heart failure with preserved ejection fraction


Heart failure


Isovolumetric pulmonary vein transit


Isovolumetric pulmonary vein transit ratio


Left atrial


Major adverse cardiovascular events


Late atrial peak emptying rate


Early atrial peak emptying rate


Atrial peak filling rate


Early peak filling rate


Receiver operator characteristic



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Gianluca Di Bella.

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

Paolo Piaggi kindly provided statistical advice for this manuscript.

Informed consent

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

Ethical approval

Institutional review board approval was obtained.


• prospective

• observational

• performed at one institution

Supplementary material

330_2018_5571_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Giovanni Donato Aquaro
    • 1
    Email author
  • Fausto Pizzino
    • 2
  • Anna Terrizzi
    • 3
  • Scipione Carerj
    • 3
  • Bijoy K. Khandheria
    • 4
  • Gianluca Di Bella
    • 3
  1. 1.Fondazione G. Monasterio CNR-ToscanaPisaItaly
  2. 2.Scuola Superiore Sant’Anna di Studi Universitari e di PerfezionamentoPisaItaly
  3. 3.Dipartimento di Medicina Clinica e SperimentaleUniversity of MessinaMessinaItaly
  4. 4.Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical CentersUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeUSA

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