Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study

Abstract

Right ventricular (RV) dysfunction is a predictor of poor outcome in patients with heart disease. Conventional imaging modalities fail to assess RV volumes accurately. We sought to assess the accuracy and reproducibility of routine breath-hold gradient echo magnetic resonance imaging (MRI)-derived RV mass, volumes and function. We assessed: (1) The accuracy of in vivo MRI-derived RV mass in comparison to the RV weight in 9 minipigs. (2) Intra- and inter-observer reproducibility of RV mass, end-diastolic (EDV) and end-systolic (ESV) volumes and ejection fraction (EF) in 15 normal volunteers and 10 patients with heart disease. (3) Inter-study reproducibility of the former parameters in 25 coronary artery disease patients. (4) The correlation between right and left ventricular stroke volumes in the total population. Strong statistically significant correlations were found between: (1) MRI-derived RV mass and RV weight (r = 0.98, bias = 2.5 g), (2) Intra-observer measurements of RV mass (r = 0.96, bias = 0.5 g), EDV (r = 0.99, bias = -1.5 ml), ESV (r = 0.98, bias = 0.1 ml) and EF (r = 0.92, bias = -1.4%), (3) Inter-observer measurements of RV mass (r = 0.95, bias = 1.1 g), EDV (r = 0.98, bias = -1.1 ml), ESV (r = 0.98, bias = 1.2 ml) and EF (r = 0.87, bias = -1.9%), (4) Inter-study measurements of RV mass (r = 0.91, bias = -0.1 g), EDV (r = 0.96, bias = 3.8 ml), ESV (r = 0.98, bias = 0.3 ml) and EF (r = 0.90, bias = 0.9%), (5) MRI-derived right and left ventricular stroke volumes (r = 0.87). The assessment of the RV mass, volumes and function by routine breath-hold gradient echo MRI is accurate and highly reproducible. The correlation between left and RV MRI-derived stroke volumes indicates excellent coherence of simultaneous bi-ventricular volume measurements.

The Prevalence and Prognostic Significance of Right Ventricular Systolic Dysfunction in Nonischemic Dilated Cardiomyopathy

“…23 The high accuracy and reproducibility of CMR estimates of RV volumes and EF have been extensively validated, albeit predominantly in healthy individuals. [15][16][17][18][19] Assessment of the interobserver and intraobserver variability in RVEF measurement in our study population generated reproducibility measures comparable to those reported in healthy subjects. [16][17][18][19] Our data therefore confirm the utility of CMR for reliable RVEF measurement in DCM, despite the adverse remodeling of the right ventricle that frequently accompanies this condition.…”

“…In contrast, cardiovascular magnetic resonance (CMR) allows noninvasive measurement of RVEF with high accuracy and reproducibility. [15][16][17][18][19] Despite the fact that CMR is now firmly established as the gold standard for RV assessment, 4,5,20 CMR data regarding the prevalence and prognostic implications of RVSD in DCM are lacking. We therefore sought to prospectively evaluate the prevalence and prognostic significance of RVSD, as assessed by CMR, in a broad spectrum of DCM patients.…”

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

“…Manual repeatability for most RV indices was similar to those in heart failure (20) and previous anterior myocardial infarction (28) (Table 2), despite our patients having larger RVs with poorer function (mean EDV and EF; PAH, 230 mL and 46%, respectively, vs. heart failure, 140 mL and 52%, respectively). If the Fulton method was used, RV mass results for PAH and heart failure were comparable (SD ¼ 5.6 vs. 6.0, respectively).…”

“…CMR studies cited to support such work have involved either healthy subjects, patients with primarily left heart disease (20,28,29) and congenital heart disease (30) but rarely those with pulmonary hypertension (2,31,32) and predominantly measured inter-and intraobserver reproducibility rather than repeatability.…”

Modified INOvent for delivery of inhaled nitric oxide during cardiac MRI

“…Cardiac magnetic resonance imaging (CMR) has emerged in recent years as the gold standard for detailed evaluation of the right ventricle (RV) [1][2][3][4][5]. CMR can be used to assess both morphological and functional aspects of the RV and pulmonary vasculature [6], and as such has a wide range of applications in right heart disease.…”