MRI assessment of left ventricular volumetrics and ejection fractions in patients with chronic ischemic heart disease in comparison with 2D echocardiography

Abstract

Background: Ischemic heart disease (IHD) is highly prevalent in developed countries and is the leading cause of death. Diagnostic imaging plays an important role in the proper assessment and management of ischemic heart disease. The new criteria incorporating imaging evidence of ischemic heart disease involve not only established modalities such as echocardiography and radionuclide imaging, but also the newer modalities, cardiovascular magnetic resonance (CMR) and cardiac computed tomography especially in presence of pitfalls and limitations in diagnosis by established modalities. Aim:To assess left ventricular volumes; end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and wall motion abnormalities by MRI in patients with chronic ischemic heart disease in comparison with 2D echocardiography. PatientsandMethods: This prospective study include examination of 50 adult patients known to have chronic ischemic heart disease with or without suspected progression of the disease came for follow up by MRI and 2D echocardiography in Cairo university and Aswan heart center (MYF) radiology and cardiology departments. MRI was done by using 1.5T machine, using SENSE (sensitivity encoding) cardiac coil (6 element phased-array coil, receive only), functional cine images, first pass perfusion images and delayed enhancement images were acquired. Echocardiography was done transthoracic (TTE) by using a 2D ultrasound machine. The left ventricle volumes and ejection fractions obtained by MRI were compared to those obtained by echocardiography and correlated with standard tables of left ventricle volumetrics. Wall motion abnormalities were assessed visually by both modalities. Results:By comparison of the diagnostic performance of MRI versus 2D echo in estimation of left ventricle volumes and ejection fraction there was agreement and strong correlation value (0.97) between both modalities however, we found that the left ventricle volumes were of lower values by echocardiography relative to MRI with statistically significant difference with P value (0.004) and we found that the EFs detected by echocardiography were of higher values relative to MRI with statistically significant difference with P value (<0.001). As regard wall motion abnormalities, both CMR and 2D echo detected the hypokinetic and akinetic left ventricle segments with no statisticaly significant difference. Conclusion: Cardiac MRI can detect the impairment in left ventricle function in patients with ischemic heart disease and is an accurate tool for assessment of left ventricle volumes and ejection fraction and can be considered as a standard reference for these issues. *= radiodiagnosis department, ^=internal medicine department- faculty of medicine-sohag unevirsity.