Abstract
Objectives
To investigate whether cardiac magnetic resonance phase-contrast imaging (PC-CMR) can determine left ventricular (LV) diastolic function in comparison to echocardiography (EC).
Background
Non-invasive evaluation of diastolic function is important for the diagnostic classification and risk stratification of patients with cardiomyopathies. With EC, diastolic function is classified based on the mitral blood flow, LV myocardial tissue Doppler velocities and pulmonary venous flow. PC-CMR has the potential to measure these parameters and may be an important tool to assess diastolic function in clinical routine.
Methods
In 36 patients with various cardiovascular diseases and 6 healthy volunteers, we performed single-slice short-axis PC-CMR at the level of the mitral leaflet tip and the inflow of the pulmonary veins to generate EC-comparable mitral E and A waves, septal and lateral e′ and a′ tissue velocities, and E/A and E/e′ ratios. EC was performed after PC-CMR in all patients and six volunteers. Patients were classified into three groups of DD for both techniques. In addition, we evaluated 120 healthy volunteers as controls (3 age groups: 1 = 20–35 years; 2 = 36–50 years; 3 ≥ 51 years) for reference values.
Results
PC-CMR correlation with EC regarding the relation of mitral E and A velocities was good (r = 0.83, p < 0.001). The correlation for the mean septal and lateral E/e′ ratio was high with r = 0.90 (p < 0.001). 40/42 subjects (95 %) were categorized correctly. The mean scan time for PC-CMR was 189 ± 16 s and mean analysis time was 348 ± 95 s. EC image acquisition time was slightly higher (201 ± 37 s, p = n.s.), whereas EC image analysis time was significantly lower (149 ± 23 s, p < 0.001).
Conclusion
The classification of DD with PC-CMR is feasible and shows good agreement with the widely accepted EC classification of DD. We present a practical approach for the clinically important assessment of DD with PC-CMR, circumventing sophisticated and time-consuming CMR sequences and specially designed software analysis tools.
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Abbreviations
- CMR:
-
Cardiac magnetic resonance
- DD:
-
Diastolic dysfunction
- EC:
-
Echocardiography
- LV:
-
Left ventricle
- MBF:
-
Mitral blood flow
- PC-CMR:
-
Phase-contrast cardiac magnetic resonance
- PVF:
-
Pulmonary vein flow
- PW-TDI:
-
Pulsed-wave time Doppler imaging
References
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009) 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 53(15):e1–e90
Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355(3):260–269
Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355(3):251–259
Achong N, Wahi S, Marwick TH (2009) Evolution and outcome of diastolic dysfunction. Heart 95(10):813–818
Persson H, Lonn E, Edner M, Baruch L, Lang CC, Morton JJ, Ostergren J, McKelvie RS (2007) Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence: results from the CHARM Echocardiographic Substudy—CHARMES. J Am Coll Cardiol 49(6):687–694
Halley CM, Houghtaling PL, Khalil MK, Thomas JD, Jaber WA (2011) Mortality rate in patients with diastolic dysfunction and normal systolic function. Arch Intern Med 171(12):1082–1087
Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S (2009) The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 54(15):1407–1424
Pennell DJ (2010) Cardiovascular magnetic resonance. Circulation 121(5):692–705. doi:10.1161/CIRCULATIONAHA.108.811547
Assomull RG, Shakespeare C, Kalra PR, Lloyd G, Gulati A, Strange J, Bradlow WM, Lyne J, Keegan J, Poole-Wilson P, Cowie MR, Pennell DJ, Prasad SK (2010) Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation 124(12):1351–1360
Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, Marino P, Smiseth OA, De Keulenaer G, Leite-Moreira AF, Borbely A, Edes I, Handoko ML, Heymans S, Pezzali N, Pieske B, Dickstein K, Fraser AG, Brutsaert DL (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(20):2539–2550
Bess RL, Khan S, Rosman HS, Cohen GI, Allebban Z, Gardin JM (2006) Technical aspects of diastology: why mitral inflow and tissue Doppler imaging are the preferred parameters? Echocardiography 23(4):332–339
Mi YP, Abdul-Khaliq H (2013) The pulsed Doppler and tissue Doppler-derived septal E/e’ ratio is significantly related to invasive measurement of ventricular end-diastolic pressure in biventricular rather than univentricular physiology in patients with congenital heart disease. Clin Res Cardiol 102(8):563–570. doi:10.1007/s00392-013-0567-0
Buss SJ, Mereles D, Emami M, Korosoglou G, Riffel JH, Bertel D, Schonland SO, Hegenbart U, Katus HA, Hardt SE (2012) Rapid assessment of longitudinal systolic left ventricular function using speckle tracking of the mitral annulus. Clin Res Cardiol 101(4):273–280. doi:10.1007/s00392-011-0389-x
Fischer-Rasokat U, Honold J, Seeger FH, Fichtlscherer S, Schachinger V, Dimmeler S, Zeiher AM, Assmus B (2012) Early remodeling processes as predictors of diastolic function 5 years after reperfused acute myocardial infarction and intracoronary progenitor cell application. Clin Res Cardiol 101(3):209–216. doi:10.1007/s00392-011-0382-4
Schuster A, Ishida M, Morton G, Bigalke B, Moonim MT, Nagel E (2012) Value of cardiovascular magnetic resonance imaging in myocardial hypertrophy. Clin Res Cardiol 101(3):237–238. doi:10.1007/s00392-011-0401-5
Li C, Lossnitzer D, Katus HA, Buss SJ (2012) Comparison of left ventricular volumes and ejection fraction by monoplane cineventriculography, unenhanced echocardiography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 28(5):1003–1010. doi:10.1007/s10554-011-9924-0
Paelinck BP, de Roos A, Bax JJ, Bosmans JM, van Der Geest RJ, Dhondt D, Parizel PM, Vrints CJ, Lamb HJ (2005) Feasibility of tissue magnetic resonance imaging: a pilot study in comparison with tissue Doppler imaging and invasive measurement. J Am Coll Cardiol 45(7):1109–1116
Bollache E, Redheuil A, Clement-Guinaudeau S, Defrance C, Perdrix L, Ladouceur M, Lefort M, De Cesare A, Herment A, Diebold B, Mousseaux E, Kachenoura N (2010) Automated left ventricular diastolic function evaluation from phase-contrast cardiovascular magnetic resonance and comparison with Doppler echocardiography. J Cardiovasc Magn Reson 12:63
Rathi VK, Doyle M, Yamrozik J, Williams RB, Caruppannan K, Truman C, Vido D, Biederman RW (2008) Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: a practical approach. J Cardiovasc Magn Reson 10:36
Gelfand EV, Hughes S, Hauser TH, Yeon SB, Goepfert L, Kissinger KV, Rofsky NM, Manning WJ (2006) Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson 8(3):503–507
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133
Khouri SJ, Maly GT, Suh DD, Walsh TE (2004) A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 17(3):290–297
Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 30(1):8–18
Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, Meverden RA, Roger VL (2006) Systolic and diastolic heart failure in the community. JAMA 296(18):2209–2216
Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102(15):1788–1794
Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK (2010) ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 121(22):2462–2508
Korosoglou G, Elhmidi Y, Steen H, Schellberg D, Riedle N, Ahrens J, Lehrke S, Merten C, Lossnitzer D, Radeleff J, Zugck C, Giannitsis E, Katus HA (2010) Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion. J Am Coll Cardiol 56(15):1225–1234. doi:10.1016/j.jacc.2010.06.020
Gorcsan J 3rd, Tanaka H (2011) Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 58(14):1401–1413
Sutherland GR, Di Salvo G, Claus P, D’Hooge J, Bijnens B (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 17(7):788–802
Jensen CJ, Eberle HC, Nassenstein K, Schlosser T, Farazandeh M, Naber CK, Sabin GV, Bruder O (2011) Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. Clin Res Cardiol 100(8):649–659. doi:10.1007/s00392-011-0290-7
Eitel I, Friedenberger J, Fuernau G, Dumjahn A, Desch S, Schuler G, Thiele H (2011) Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function. The randomised Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI). Clin Res Cardiol 100(5):425–432. doi:10.1007/s00392-010-0260-5
Kane GC, Karon BL, Mahoney DW, Redfield MM, Roger VL, Burnett JC Jr, Jacobsen SJ, Rodeheffer RJ (2011) Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 306(8):856–863
Aljaroudi W, Alraies MC, Halley C, Rodriguez L, Grimm RA, Thomas JD, Jaber WA (2012) Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation 125(6):782–788
Bellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, Pennell DJ (2000) Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J 21(16):1387–1396
Patel MR, White RD, Abbara S, Bluemke DA, Herfkens RJ, Picard M, Shaw LJ, Silver M, Stillman AE, Udelson J (2013) 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: a joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol 61(21):2207–2231. doi:10.1016/j.jacc.2013.02.005
Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN, Makowski MR, Bigalke B, Perera D, Beerbaum P, Nagel E (2013) The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol 82(2):296–301. doi:10.1016/j.ejrad.2012.11.012
Neizel M, Korosoglou G, Lossnitzer D, Kuhl H, Hoffmann R, Ocklenburg C, Giannitsis E, Osman NF, Katus HA, Steen H (2010) Impact of systolic and diastolic deformation indexes assessed by strain-encoded imaging to predict persistent severe myocardial dysfunction in patients after acute myocardial infarction at follow-up. J Am Coll Cardiol 56(13):1056–1062. doi:10.1016/j.jacc.2010.02.070
Ceelen F, Hunter RJ, Boubertakh R, Sommer WH, Armbruster M, Schilling RJ, Petersen SE (2013) Effect of atrial fibrillation ablation on myocardial function: insights from cardiac magnetic resonance feature tracking analysis. Int J Cardiovasc Imaging. doi:10.1007/s10554-013-0287-6
Rubinshtein R, Glockner JF, Feng D, Araoz PA, Kirsch J, Syed IS, Oh JK (2009) Comparison of magnetic resonance imaging versus Doppler echocardiography for the evaluation of left ventricular diastolic function in patients with cardiac amyloidosis. Am J Cardiol 103(5):718–723
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30(6):1527–1533
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Buss, S.J., Krautz, B., Schnackenburg, B. et al. Classification of diastolic function with phase-contrast cardiac magnetic resonance imaging: validation with echocardiography and age-related reference values. Clin Res Cardiol 103, 441–450 (2014). https://doi.org/10.1007/s00392-014-0669-3
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DOI: https://doi.org/10.1007/s00392-014-0669-3