Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 2 (Diastolic and Regional Assessment)

  • Menhel Kinno
  • Prashant Nagpal
  • Stephen Horgan
  • Alfonso H. Waller
Echocardiography (JM Gardin, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Echocardiography


Assessing left ventricular diastolic and regional function is a crucial part of the cardiovascular evaluation. Diastolic function is as important as systolic function for left ventricular performance because it is the determinant of the ability of the left atrium and ventricle to fill at relatively low pressures. Additionally, diastolic function plays an important role in the management and prognosis of patients with symptoms and signs of heart failure. Technical advances in the imaging modalities have allowed a comprehensive noninvasive assessment of global and regional cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare clinically available techniques and novel approaches using echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of diastolic and regional left ventricular function.


Echocardiography Cardiac magnetic resonance imaging Cardiac mechanics Computed tomographic imaging Diastolic function Regional myocardial function Strain Strain rate 



American Society of Echocardiography


Cardiac magnetic resonance imaging




Pulmonary venous diastolic flow wave


Displacement encoding with stimulated echoes


Dual source computed tomography


Deceleration time


Early transmitral flow velocity


Early diastolic velocity of the mitral annulus


European Association of Cardiovascular Imaging




Extracellular volume


Ejection fraction


Feature-tracking magnetic resonance imaging


Heart failure with preserved ejection fraction


Heart failure with reduced ejection fraction


Isovolumetric relaxation time


Left atrial


Left ventricular


Left ventricular end-diastolic pressure


Multidetector computed tomography




Pulmonary venous systolic flow wave


Strain-encoded imaging


Spatial modulation of magnetization


Strain rate during early diastole


Strain rate during isovolumetric relaxation


Balanced steady-state free precession


Stretch Quantifier of Endocardial Engraved Zones


Tissue Doppler imaging


Tissue phase mapping


M-mode flow propagation velocity


Load-independent passive LV stiffness constant


Tau or time constant of left ventricular pressure decay




Compliance with Ethical Standards

Conflict of Interest

Menhel Kinno, Prashant Nagpal, Stephen Horgan, and Alfonso H. Waller declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002;105(11):1387–93.CrossRefPubMedGoogle Scholar
  2. 2.
    Yamada H, Klein AL. Diastology 2010: clinical approach to diastolic heart failure. J Echocardiogr. 2010;8(3):65–79.CrossRefPubMedGoogle Scholar
  3. 3.
    Yancy CW et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.CrossRefPubMedGoogle Scholar
  4. 4.
    Gardin JM et al. Relationship of Doppler-echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. Am Heart J. 2009;158(4 Suppl):S45–52.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cavalcante JL et al. Diastolic function improvement is associated with favourable outcomes in patients with acute non-ischaemic cardiomyopathy: insights from the multicentre IMAC-2 trial. Eur Heart J Cardiovasc Imaging. 2016;17(9):1027–35.CrossRefPubMedGoogle Scholar
  6. 6.
    •• Nagueh SF et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314. This document provides a comprehensive practical approach for the assessment of LV diastolic function utlitizing Echo.CrossRefPubMedGoogle Scholar
  7. 7.
    • Flachskampf FA et al. Cardiac imaging to evaluate left ventricular diastolic function. J Am Coll Cardiol Img. 2015;8(9):1071–93. This study provides a thorough review about the current and experimental multimodality immaging parameters for the assessment of the LV diastolic function.CrossRefGoogle Scholar
  8. 8.
    • Mor-Avi V et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24(3):277–313. This document provides a detailed information about the echocardiographic techniques utilized for the assessment of cardiac mechanics and the clinical applications of these techniques.CrossRefPubMedGoogle Scholar
  9. 9.
    Kinno M, et al. Comparison of echocardiography, cardiac magnetic resonance, and computed tomographic imaging for the evaluation of left ventricular myocardial function: part 1 (global assessment). Curr Cardiol Rep. 2016.Google Scholar
  10. 10.
    Thomas JD, Popovic ZB. Assessment of left ventricular function by cardiac ultrasound. J Am Coll Cardiol. 2006;48(10):2012–25.CrossRefPubMedGoogle Scholar
  11. 11.
    Lang RM, et al. ASE’s Comprehensive echocardiography. 2nd ed. Philadelphia, PA: Elsevier Saunders. 879; 2016. p. 19103–2899Google Scholar
  12. 12.
    Opdahl A et al. Determinants of left ventricular early-diastolic lengthening velocity: independent contributions from left ventricular relaxation, restoring forces, and lengthening load. Circulation. 2009;119(19):2578–86.CrossRefPubMedGoogle Scholar
  13. 13.
    Wang J et al. Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation. 2007;115(11):1376–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Dokainish H et al. Usefulness of new diastolic strain and strain rate indexes for the estimation of left ventricular filling pressure. Am J Cardiol. 2008;101(10):1504–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Adhyapak SM, Parachuri VR. Architecture of the left ventricle: insights for optimal surgical ventricular restoration. Heart Fail Rev. 2010;15(1):73–83.CrossRefPubMedGoogle Scholar
  16. 16.
    Sengupta PP et al. Twist mechanics of the left ventricle: principles and application. J Am Coll Cardiol Img. 2008;1(3):366–76.CrossRefGoogle Scholar
  17. 17.
    Takeuchi M et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging. J Am Soc Echocardiogr. 2006;19(9):1077–84.CrossRefPubMedGoogle Scholar
  18. 18.
    Wang J et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation. 2007;116(22):2580–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Park SJ et al. Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. J Am Soc Echocardiogr. 2008;21(10):1129–37.CrossRefPubMedGoogle Scholar
  20. 20.
    Notomi Y et al. Ventricular untwisting: a temporal link between left ventricular relaxation and suction. Am J Physiol Heart Circ Physiol. 2008;294(1):H505–13.CrossRefPubMedGoogle Scholar
  21. 21.
    Brun P et al. Left ventricular flow propagation during early filling is related to wall relaxation: a color M-mode Doppler analysis. J Am Coll Cardiol. 1992;20(2):420–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Hsu PC et al. The ratio of early mitral inflow velocity to global diastolic strain rate as a useful predictor of cardiac outcomes in patients with atrial fibrillation. J Am Soc Echocardiogr. 2014;27(7):717–25.CrossRefPubMedGoogle Scholar
  23. 23.
    Ersboll M et al. Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study. Eur Heart J. 2014;35(10):648–56.CrossRefPubMedGoogle Scholar
  24. 24.
    Wakami K et al. Correlation between left ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole. J Am Soc Echocardiogr. 2009;22(7):847–51.CrossRefPubMedGoogle Scholar
  25. 25.
    Kurt M et al. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2(1):10–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Hartiala JJ et al. Velocity-encoded cine MRI in the evaluation of left ventricular diastolic function: measurement of mitral valve and pulmonary vein flow velocities and flow volume across the mitral valve. Am Heart J. 1993;125(4):1054–66.CrossRefPubMedGoogle Scholar
  27. 27.
    Paelinck BP et al. Feasibility of tissue magnetic resonance imaging: a pilot study in comparison with tissue Doppler imaging and invasive measurement. J Am Coll Cardiol. 2005;45(7):1109–16.CrossRefPubMedGoogle Scholar
  28. 28.
    Ambale-Venkatesh B et al. Diastolic function assessed from tagged MRI predicts heart failure and atrial fibrillation over an 8-year follow-up period: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imaging. 2014;15(4):442–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Ellims AH et al. Diffuse myocardial fibrosis evaluated by post-contrast t1 mapping correlates with left ventricular stiffness. J Am Coll Cardiol. 2014;63(11):1112–8.CrossRefPubMedGoogle Scholar
  30. 30.
    • Rommel KP et al. Extracellular volume fraction for characterization of patients with heart failure and preserved ejection fraction. J Am Coll Cardiol. 2016;67(15):1815–25. This study provides evidence that CMR-derived T1 mapping, a technique to quantify diffuse myocardial fibrosis, can independently predict invasively measured LV stiffness in patients with HFpEF.CrossRefPubMedGoogle Scholar
  31. 31.
    Su MY et al. CMR-verified diffuse myocardial fibrosis is associated with diastolic dysfunction in HFpEF. J Am Coll Cardiol Img. 2014;7(10):991–7.CrossRefGoogle Scholar
  32. 32.
    Collins JD. Global and regional functional assessment of ischemic heart disease with cardiac MR imaging. Radiol Clin N Am. 2015;53(2):369–95.CrossRefPubMedGoogle Scholar
  33. 33.
    •• Lang RM et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.e14. This document provide a comprehensive guidelines for the echocardiographic chamber quantification as recommended by the ASE/EACVI.CrossRefPubMedGoogle Scholar
  34. 34.
    Cerqueira MD et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Raff GL et al. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 2009;3(2):122–36.CrossRefPubMedGoogle Scholar
  36. 36.
    Hundley WG et al. Society for cardiovascular magnetic resonance guidelines for reporting cardiovascular magnetic resonance examinations. J Cardiovasc Magn Reson. 2009;11:5.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Heimdal A et al. Real-time strain rate imaging of the left ventricle by ultrasound. J Am Soc Echocardiogr. 1998;11(11):1013–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Leitman M et al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr. 2004;17(10):1021–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Stefani L et al. Two-dimensional tracking and TDI are consistent methods for evaluating myocardial longitudinal peak strain in left and right ventricle basal segments in athletes. Cardiovasc Ultrasound. 2007;5:7.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Lamash Y et al. Strain analysis from 4-D cardiac CT image data. IEEE Trans Biomed Eng. 2015;62(2):511–21.CrossRefPubMedGoogle Scholar
  41. 41.
    Rizvi A et al. Analysis of ventricular function by CT. J Cardiovasc Comput Tomogr. 2015;9(1):1–12.CrossRefPubMedGoogle Scholar
  42. 42.
    Cerqueira MD, Harp GD, Ritchie JL. Quantitative gated blood pool tomographic assessment of regional ejection fraction: definition of normal limits. J Am Coll Cardiol. 1992;20(4):934–41.CrossRefPubMedGoogle Scholar
  43. 43.
    Zeb I et al. Computerized left ventricular regional ejection fraction analysis for detection of ischemic coronary artery disease with multidetector CT angiography. Int J Cardiovasc Imaging. 2013;29(3):685–92.CrossRefPubMedGoogle Scholar
  44. 44.
    Pourmorteza A et al. Regional cardiac function assessment in 4D CT: comparison between SQUEEZ and ejection fraction. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:4966–9.PubMedGoogle Scholar
  45. 45.
    • Pourmorteza A et al. A new method for cardiac computed tomography regional function assessment: stretch quantifier for endocardial engraved zones (SQUEEZ). Circ Cardiovasc Imaging. 2012;5(2):243–50. This study provides evidence that the regional myocardial function obtained by CT SQUEEZ, assessed among 162 segments in the 9 hearts, has good correlation with the tagged MRI as a reference standard for noninvasive regional myocardial function.CrossRefPubMedGoogle Scholar
  46. 46.
    Pourmorteza A. et al. Correlation of CT-based regional cardiac function (SQUEEZ) with myocardial strain calculated from tagged MRI: an experimental study. Int J Cardiovasc Imaging. 2015.Google Scholar
  47. 47.
    Bansal M, Sengupta PP. Longitudinal and circumferential strain in patients with regional LV dysfunction. Curr Cardiol Rep. 2013;15(3):339.CrossRefPubMedGoogle Scholar
  48. 48.
    Schuster A et al. Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress. J Cardiovasc Magn Reson. 2011;13:58.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Hor KN et al. Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis. J Am Coll Cardiol Img. 2010;3(2):144–51.CrossRefGoogle Scholar
  50. 50.
    Kuetting D et al. Comparison of magnetic resonance feature tracking with harmonic phase imaging analysis (CSPAMM) for assessment of global and regional diastolic function. Eur J Radiol. 2015;84(1):100–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Jeung MY et al. Myocardial tagging with MR imaging: overview of normal and pathologic findings. Radiographics. 2012;32(5):1381–98.CrossRefPubMedGoogle Scholar
  52. 52.
    Jung B et al. Investigating myocardial motion by MRI using tissue phase mapping. Eur J Cardiothorac Surg. 2006;29 Suppl 1:S150–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Kim D, Kellman P. Improved cine displacement-encoded MRI using balanced steady-state free precession and time-adaptive sensitivity encoding parallel imaging at 3 T. NMR Biomed. 2007;20(6):591–601.CrossRefPubMedGoogle Scholar
  54. 54.
    Simpson RM, Keegan J, Firmin DN. MR assessment of regional myocardial mechanics. J Magn Reson Imaging. 2013;37(3):576–99.CrossRefPubMedGoogle Scholar
  55. 55.
    Osman NF et al. Imaging longitudinal cardiac strain on short-axis images using strain-encoded MRI. Magn Reson Med. 2001;46(2):324–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Menhel Kinno
    • 1
  • Prashant Nagpal
    • 2
  • Stephen Horgan
    • 3
  • Alfonso H. Waller
    • 1
    • 4
  1. 1.Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, RutgersThe State University of New JerseyNewarkUSA
  2. 2.Department of Radiology, Carver College of MedicineUniversity of IowaIowa CityUSA
  3. 3.Department of Cardiovascular Medicine, Morristown Medical CenterGagnon Cardiovascular InstituteMorristownUSA
  4. 4.Department of Radiology, Rutgers New Jersey Medical School, RutgersThe State University of New JerseyNewarkUSA

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