Diastolic dysfunction evaluated by cardiac magnetic resonance: the value of the combined assessment of atrial and ventricular function
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.
• 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.
KeywordsDiastole Magnetic resonance Heart failure Physiology: atrial function Hypertrophic cardiomyopathy
Cardiac magnetic resonance
Heart failure with preserved ejection fraction
Isovolumetric pulmonary vein transit
Isovolumetric pulmonary vein transit ratio
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• performed at one institution
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