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European Radiology

, Volume 29, Issue 3, pp 1555–1564 | Cite as

Diastolic dysfunction evaluated by cardiac magnetic resonance: the value of the combined assessment of atrial and ventricular function

  • Giovanni Donato AquaroEmail author
  • Fausto Pizzino
  • Anna Terrizzi
  • Scipione Carerj
  • Bijoy K. Khandheria
  • Gianluca Di Bella
Cardiac

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

Analysis of LV and LA V/t curves by CMR may be useful for the evaluation of DD.

Key Points

• 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.

Keywords

Diastole Magnetic resonance Heart failure Physiology: atrial function Hypertrophic cardiomyopathy 

Abbreviations

CMR

Cardiac magnetic resonance

DD

Diastolic dysfunction

HF-p-EF

Heart failure with preserved ejection fraction

HF

Heart failure

IPVT

Isovolumetric pulmonary vein transit

IPVTR

Isovolumetric pulmonary vein transit ratio

LA

Left atrial

MACE

Major adverse cardiovascular events

PER-A

Late atrial peak emptying rate

PER-E

Early atrial peak emptying rate

PFR-A

Atrial peak filling rate

PFR-E

Early peak filling rate

ROC

Receiver operator characteristic

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

Supplementary material

330_2018_5571_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Giovanni Donato Aquaro
    • 1
    Email author
  • Fausto Pizzino
    • 2
  • Anna Terrizzi
    • 3
  • Scipione Carerj
    • 3
  • Bijoy K. Khandheria
    • 4
  • Gianluca Di Bella
    • 3
  1. 1.Fondazione G. Monasterio CNR-ToscanaPisaItaly
  2. 2.Scuola Superiore Sant’Anna di Studi Universitari e di PerfezionamentoPisaItaly
  3. 3.Dipartimento di Medicina Clinica e SperimentaleUniversity of MessinaMessinaItaly
  4. 4.Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical CentersUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeUSA

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