European Radiology

, Volume 29, Issue 5, pp 2360–2368 | Cite as

Evaluation of elevated left ventricular end diastolic pressure in patients with preserved ejection fraction using cardiac magnetic resonance

  • Chengjie Gao
  • Yijing Tao
  • Jingwei PanEmail author
  • Chengxing ShenEmail author
  • Jiayin Zhang
  • Zhili Xia
  • Qing Wan
  • Hao Wu
  • Yajie Gao
  • Hong Shen
  • Zhigang Lu
  • Meng Wei



This study aims to validate the reliability of cardiac magnetic resonance (CMR) parameters for estimating left ventricular end diastolic pressure (LVEDP) in heart failure patients with preserved ejection fraction (HFpEF) and compare their accuracy to conventional echocardiographic ones, with reference to left heart catheterisation.


Sixty patients with exertional dyspnoea (New York Heart Association function class II to III) were consecutively enrolled. CMR-derived time-volume curve and deformation parameters, conventional echocardiographic diastolic indices as well as LVEDP evaluated by left heart catheterisation were collected and analysed.


Fifty-one patients, who accomplished all three examinations, were divided into HFpEF group and non-HFpEF group based on LVEDP measurements. Compared to the non-HFpEF group, CMR-derived time-volume curve showed lower peak filling rate adjusted for end diastolic volume (PFR/EDV, p = 0.027), longer time to peak filling rate (T-PFR, p < 0.001), and increased T-PFR in one cardiac cycle (%T-PFR, p < 0.001) in HFpEF group. In multivariable linear regression analysis, %T-PFR (β = 0.372, p = 0.024), left ventricular global peak longitudinal diastolic strain rate (LDSR, β = −0.471, p = 0.006), and E/e’ (β = 0.547, p = 0.001) were independently associated with invasively measured LVEDP. The sensitivity and specificity of E/e’ and LDSR for predicting the elevated LVEDP were 76%, 92% and 76%, 89%, respectively.


These findings suggest that CMR-derived time-volume curve and strain indices could predict HFpEF patients. Not only E/e’ assessed by echocardiography but also the CMR-derived %T-PFR and LDSR correlated well with LVEDP. These non-invasive parameters were validated to evaluate the left ventricular diastolic function.

Key Points

The abnormal time-volume curve revealed insufficient early diastole in HFpEF patients.

Non-invasive parameters including E/e’, %T-PFR, and LDSR correlated well with LVEDP.


Heart failure, diastolic Ventricular function, left Ventricular pressure Magnetic resonance imaging 



Time to peak filling rate in one cardiac cycle


American Society of Echocardiography


Body mass index


Brain natriuretic peptide


Body surface area


Left ventricular global peak circumferential diastolic strain rate


Cardiac magnetic resonance


End diastolic volume


Estimated glomerular filtration rate


Heart failure


Heart failure with preserved ejection fraction


Heart failure with reduced ejection fraction


Intraclass correlation coefficient


BSA-indexed left atrial volume


Left ventricular global peak longitudinal diastolic strain rate


Left ventricular


Left ventricular end diastolic pressure


BSA-indexed LV end diastolic volume


Left ventricular ejection fraction


BSA-indexed LV end-systolic volume


BSA-indexed LV mass


Peak filling rate


Peak filling rate adjusted for end diastolic volume


Peak filling volume


Left ventricular global peak radial diastolic strain rate


Time to peak filling rate


Tissue Doppler imaging



This study has received funding by Grant No. LYZY-0193 (study the parameters to identify different prognosis of patients with non-ischemia cardiomyopathy.) from the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital.

Compliance with ethical standards


The scientific guarantor of this publication is Jingwei Pan.

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

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.


• perspective

• observational

• performed at one institution


  1. 1.
    Aziz F, Thazhatauveetil-Kunhahamed LA, Enweluzo C, Zaeem M (2013) Heart failure with preserved EF: a bird eye view. JNMA J Nepal Med Assoc 52:405–412. Google Scholar
  2. 2.
    Borlaug BA, Paulus WJ (2011) Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 32:670–679. CrossRefGoogle Scholar
  3. 3.
    Steinberg BA, Zhao X, Heidenreich PA et al (2012) Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 126:65–75. CrossRefGoogle Scholar
  4. 4.
    Paulus WJ, Tschöpe C, Sanderson JE et al (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 28:2539–2550. CrossRefGoogle Scholar
  5. 5.
    von Knobelsdorff-Brenkenhoff F, Pilz G, Schulz-Menger J (2017) Representation of cardiovascular magnetic resonance in the AHA/ACC guidelines. J Cardiovasc Magn Reson 19:70. CrossRefGoogle Scholar
  6. 6.
    Mendoza DD, Codella NC, Wang Y et al (2010) Impact of diastolic dysfunction severity on global left ventricular volumetric filling-assessment by automated segmentation of routine cine cardiovascular magnetic resonance. J Cardiovasc Magn Reson 12:46. CrossRefGoogle Scholar
  7. 7.
    Göransson C, Vejlstrup N, Carlsen J (2018) Reproducibility of peak filling and peak emptying rate determined by cardiovascular magnetic resonance imaging for assessment of biventricular systolic and diastolic dysfunction in patients with pulmonary arterial hypertension. Int J Cardiovasc Imaging 34:777–786. Google Scholar
  8. 8.
    Tao YJ, Gao CJ, Wu H et al (2017) Application of cardiac magnetic resonance cine imaging in diagnosis and treatment of heart failure with preserved ejection fraction. Acad J Second Mil Med Uni 38:1273–1278. Google Scholar
  9. 9.
    Kuetting D, Sprinkart AM, Doemer J, Schild H, Thomas D (2015) Comparison of magnetic resonance feature trackking with harmonic phase imaging analysis (CSPAMM) for assessment of global and regional diastolic function. Eur J Radiol 84:100–107. CrossRefGoogle Scholar
  10. 10.
    Patel D, Robinson VJ, Arteaga RB, Thornton JW (2008) Diastolic filling parameters derived from myocardial perfusion imaging can predict left ventricular end-diastolic pressure at subsequent cardiac catheterization. J Nucl Med 49:746–751. CrossRefGoogle Scholar
  11. 11.
    ASCI CCT and CMR Guideline Working Group, Chan CW, Choi BW et al (2010) ASCI 2010 standardized practice protocol for cardiac magnetic resonance imaging: a report of the Asian society of cardiovascular imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group. Int J Cardiovasc Imaging 26:187–202. CrossRefGoogle Scholar
  12. 12.
    Westenberg JJM (2011) CMR for assessment of diastolic function. Curr Cardiovasc Imaging Rep 4:149–158. CrossRefGoogle Scholar
  13. 13.
    Hieda M, Parker J, Rajabi T et al (2018) Left ventricular volume-time relation in patients with heart failure with preserved ejection fraction. Am J Cardiol 121:609–614. CrossRefGoogle Scholar
  14. 14.
    Sharifov OF, Schiros CG, Aban I, Denney TS, Gupta H (2016) Diagnostic accuracy of tissue doppler index E/e’ for evaluating left ventricular filling pressure and diastolic dysfunction/ heart failure with preserved ejection fraction: a systematic review and meta-analysis. J Am Heart Assoc 25:5. Google Scholar
  15. 15.
    Lancellotti P, Galderisi M, Edvardsen T et al (2017) Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI euro-filling study. Eur Heart J Cardiovasc Imaging 18:961–968. CrossRefGoogle Scholar
  16. 16.
    Andersen OS, Smiseth OA, Dokainish H et al (2017) Estimating left ventricular filling pressure by echocardiography. J Am Coll Cardiol 69:1937–1948. CrossRefGoogle Scholar
  17. 17.
    Watanabe T, Iwai-Takano M, Oikawa M, Yamaki T, Yaoita H, Maruyama Y (2008) Optimal noninvasive assessment of diastolic heart failure in patients with atrial fibrillation: comparison of tissue Doppler echocardiography, left atrium size, and brain natriuretic peptide. J Am Soc Echocardiogr 21:689–696. CrossRefGoogle Scholar
  18. 18.
    Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol 53:1119–1126. CrossRefGoogle Scholar
  19. 19.
    Wang J, Khoury DS, Thohan V, Torre-Amione G, Nagueh SH (2007) Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation 115:1376–1383.
  20. 20.
    Morris DA, Takeuchi M, Nakatani S et al (2018) Lower limit of normality and clinical relevance of left ventricular early diastolic strain rate for the detection of left ventricular diastolic dysfunction. Eur Heart J Cardiovasc Imaging 19:905–915. CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of GeriatricsShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  2. 2.Department of CardiologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  3. 3.Department of RadiologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina

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