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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
Cardiac

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Abbreviations

%T-PFR

Time to peak filling rate in one cardiac cycle

ASE

American Society of Echocardiography

BMI

Body mass index

BNP

Brain natriuretic peptide

BSA

Body surface area

CDSR

Left ventricular global peak circumferential diastolic strain rate

CMR

Cardiac magnetic resonance

EDV

End diastolic volume

EGFR

Estimated glomerular filtration rate

HF

Heart failure

HFpEF

Heart failure with preserved ejection fraction

HFrEF

Heart failure with reduced ejection fraction

ICC

Intraclass correlation coefficient

LAVI

BSA-indexed left atrial volume

LDSR

Left ventricular global peak longitudinal diastolic strain rate

LV

Left ventricular

LVEDP

Left ventricular end diastolic pressure

LVEDVI

BSA-indexed LV end diastolic volume

LVEF

Left ventricular ejection fraction

LVESVI

BSA-indexed LV end-systolic volume

LVMI

BSA-indexed LV mass

PFR

Peak filling rate

PFR/EDV

Peak filling rate adjusted for end diastolic volume

PFV

Peak filling volume

RDSR

Left ventricular global peak radial diastolic strain rate

T-PFR

Time to peak filling rate

TDI

Tissue Doppler imaging

Notes

Funding

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

Guarantor

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.

Methodology

• perspective

• observational

• performed at one institution

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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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