Abstract
ObjectivesTo examine relationships between severity of echocardiography (echo) -evidenced diastolic dysfunction (DD) and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR).BackgroundCine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Automated segmentation (LV-METRIC) yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD.Methods115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR), time to peak filling rate (TPFR), and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume). Echo was the reference for DD.ResultsLV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (≤ 1% inter-reader differences) and required minimal processing time (175 ± 34 images/exam, 2:09 ± 0:51 minutes). CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p < 0.001). PFR by CMR increased with DD grade, similar to E/e' (p < 0.001). Prolonged DVR80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%). The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001) with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06), whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02) DD.ConclusionsAutomated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged filling intervals whereas restrictive filling is characterized by increased filling rates.
Highlights
Cine-Cardiovascular magnetic resonance (CMR) provides high-resolution assessment of left ventricular (LV) chamber volumes
peak filling rate (PFR) by CMR increased with diastolic dysfunction (DD) grade, similar to E/e’ (p < 0.001)
Prolonged DVR80 was associated with grade 1 with a similar trend for grade 2, whereas high PFR was associated with grade 3 DD
Summary
Cine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Echocardiography (echo) identifies DD based on mitral inflow or myocardial compliance sampled at regional myocardial locations [4,5] This approach is potentially limited by localized changes in LV contractility and myocardial tissue composition, affecting regional compliance but not necessarily impacting global diastolic performance [4,6]. Global LV filling curves, which have been previously employed using radionuclide imaging techniques such as RNCA and SPECT, provide an alternative means of assessing diastolic physiology based on timing and pattern of dynamic changes in LV chamber volumes [7,8,9,10]. All patients had normal systolic function, retrospective data was used for validation, and the relation between cine-CMR filling parameters and graded severity of DD was not evaluated
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