Evaluation of elevated left ventricular end diastolic pressure in patients with preserved ejection fraction using cardiac magnetic resonance
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.
• 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.
KeywordsHeart 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 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 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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
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