Impact of Papillary Muscles in Ventricular Volume and Ejection Fraction Assessment by Cardiovascular Magnetic Resonance

Abstract

Cardiovascular magnetic resonance (CMR) is an accurate tool for the determination of right and left ventricular volumes and ejection fractions. However, the current standard short-axis technique is time-consuming and thus, often not practicable for routine daily use, because papillary muscles and trabeculations have to be marked and their volumes subtracted from the total ventricular volume. To reduce calculation time we evaluated the volumetric data that included papillary muscle and trabecular volumes and compared the outcome with the results of the standard technique. Thirty patients (17 healthy, 13 with coronary heart disease) were examined by CMR using TrueFISP (Magnetom, Siemens, Erlangen, Germany). Right and left ventricular volumes and ejection fractions were calculated using the standard short-axis technique and then again without subtracting papillary and trabecular volumes. The two methods were compared by determining the differences in results for ventricular volumes and ejection fractions. Statistically significant differences were found between the two methods for right and left ventricular stroke volumes and end-systolic volumes, and left ventricular end-diastolic volumes (EDV) (p < or = 0.011). No significant difference was found for right ventricular end-diastolic volumes (p > or = 0.149) or left or right ventricular ejection fraction (p > or = 0.130). Except in the case of left ventricular EDV, the deviations in the results of method 1 and method 2 did not vary significantly with the presence or absence of heart disease. Measurements were obtained considerably more quickly with the modified method than with the standard short-axis method (25 +/- 4 min vs. 13 +/- 3 min, p = 0.000). Although systematic differences were found when papillary and trabecular volumes were not subtracted, these differences are small and may not be of clinical relevance in healthy subjects or patients with coronary heart disease. Not subtracting the volumes of these structures enables faster determination of right and left ventricular volumes and ejection fractions without loss of the accuracy associated with the standard short-axis technique.

Measuring the heart in pulmonary arterial hypertension (PAH): Implications for trial study size

“…As for volumetric measurements (43), including trabeculae and papillary muscles with blood pool shortened mass analysis time. However, this compromised repeatability because of the difficulty of separating these hypertrophied structures from adjoining RV.…”

Reference values for quantitative left ventricular and left atrial measurements in cardiac computed tomography

“…This would require relatively homogenous contrast attenuation in the right heart that is challenging with CT. Fourth, the papillary muscles were included into volume measurements as part of the LV cavity. On the other hand, the impact of inclusion or exclusion of papillary muscles on global LV function assessment has been shown to be negligible [43]. Fifth, dimensional measurements were obtained at the chorda level.…”

NT-proBNP can be used to detect right ventricular systolic dysfunction in pulmonary hypertension

“…CMR analysis was performed before blood samples were analysed for NT-proBNP levels. RV and LV volumes (RV end-diastolic, RV end-systolic, LV end-diastolic and LV end-systolic volumes) were determined by manual planimetry of selected short-axis images, as described previously [29,30]. RV and LV ventricular stroke volume (RVSV and LVSV), RVEF and LV ejection fraction, and RV and LV mass (RVM and LVM) were determined as previously described [29,30].…”