Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: A practical approach

Rathi, Vikas K; Doyle, Mark; Yamrozik, June; Williams, Ronald; Caruppannan, Ketheswaram; Truman, Craig; Vido, Diane A; Biederman, Robert W

doi:10.1186/1532-429x-10-36

Cited by 134 publications

(96 citation statements)

References 26 publications

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“…Assessment of mitral inflow and pulmonary vein flow by CMRI phase-contrast imaging is based on similar parameters to those obtained by Doppler echocardiography and reflects the LV filling pattern (7)(8)(9). Pressure gradients can also be calculated using the modified Bernoulli equation: Pressure gradient (mmHg)=4V max 2 (m/s), where V max is the peak velocity (10).…”

Section: Mitral Inflow and Pulmonary Venous Flow Imagingmentioning

confidence: 99%

Assessment of left ventricular diastolic function by mr: what radiologists should know

Duarte¹,

Fernández-Pérez²,

Bettencourt³

et al. 2012

Diagn Interv Radiol

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446 In clinical practice, heart failure (HF), caused by a predominant abnormality in diastolic function, is a common entity and a cause of significant morbidity and mortality. According to the American Heart Association, the prevalence of HF in adults was 5.3 million in 2005, of which almost half had a normal left ventricular (LV) ejection fraction (EF) (1). Diastolic dysfunction occurs when LV relaxation and/or compliance are impaired and is considered an early marker of cardiovascular disease (2). Diastolic HF is a clinical entity, and the diagnosis requires three conditions: the presence of signs or symptoms of HF, normal or slightly abnormal LV systolic function (EF >50%), and demonstration of LV diastolic dysfunction (3). Assessment of diastolic function by cardiovascular magnetic resonance imaging (CMRI) is feasible and could provide a more comprehensive clinical understanding of LV function in addition to a systolic functional assessment. LV diastolic dysfunction occurs in several cardiac and systemic diseases such as hypertension, ischemic heart disease, hypertrophic cardiomyopathy, aortic valve stenosis, and infiltrative cardiomyopathies such as amyloidosis (4).The purpose of this study was to review the pathophysiology of diastolic dysfunction, to illustrate the different degrees of diastolic dysfunction, and to provide an overview of the role of CMRI in the assessment of diastolic dysfunction. Physiology of diastoleDiastole represents the portion of the cardiac cycle that begins with isovolumic relaxation and ends with mitral valve (MV) closure, leading to ventricular filling (5).Diastole can be divided into four phases ( Fig. 1): 1) Isovolumic relaxation: Relaxation is an energy-dependent process that starts in late systole and ends in mid-diastole. The elastic recoil of the contracted myocardium creates a "suction" mechanism causing the intra-ventricular pressure to decline, while maintaining a virtually constant volume. 2) Rapid filling: Pressure continues to decline due to LV relaxation and elastic recoil until it is below the left atrial (LA) pressure so the MV will open, and rapid filling begins. It ends when LV pressure equals LA pressure and is responsible for nearly 70% of LV filling. 3) Diastasis: It is the period between rapid filling and atrial contraction, when LA and LV pressures have reached an equilibrium. LV filling continues because of the inertia of pulmonary venous return flow, accounting for <5% of LV filling. 4) Atrial contraction: This corresponds to the LA contraction that causes LA pressure to rise above the ventricular pressure; it induces new blood flow into the LV and accounts for nearly 25% of LV filling (4). ABSTRACT Diastolic dysfunction is a common entity and the predominant cause of heart failure in 40%-50% of patients. Diagnosis of diastolic dysfunction is clinically relevant and associated with a poor prognosis. The aim of this essay was to review the pathophysiology and different grades of diastolic dysfunction and to provide an overview on the role of cardiovascula...

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Section: Mitral Inflow and Pulmonary Venous Flow Imagingmentioning

confidence: 99%

Assessment of left ventricular diastolic function by mr: what radiologists should know

Duarte¹,

Fernández-Pérez²,

Bettencourt³

et al. 2012

Diagn Interv Radiol

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“…Over the last decade, cardiovascular magnetic resonance (CMR) imaging has been widely accepted as the "gold standard" for the assessment of cardiac structure and function because of its high spatial and temporal resolution, excellent image quality and lack of geometric assumptions [2]. CMR offers a variety of alternative approaches for evaluating diastolic function [3].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular magnetic resonance imaging assessment of diastolic dysfunction in a population without heart disease: a gender-based study

et al. 2013

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Objectives Asymptomatic left ventricular (LV) diastolic dysfunction is increasingly recognised as an important diagnosis. Our goal was to study the prevalence and gender differences in subclinical LV diastolic dysfunction, using cardiovascular magnetic resonance imaging (CMR) at 3 T. Methods We prospectively studied 48 volunteers (19 male and 29 female, mean age 49±7 years) with no evidence of cardiovascular disease. We used CMR to measure left atrium (LA) and LV volumes, LV peak filling rate and transmitral flow.Results The overall prevalence of LV diastolic dysfunction in our cohort varied between 20 % (based on evaluation of LV filing profiles) and 24 % (based on the evaluation of the transmitral flow). The prevalence of diastolic dysfunction was higher in men than in women, independently of the criteria used (P between 0.004 and 0.022). Indexed LV end-diastolic volume, indexed LV stroke volume, indexed LV mass, indexed LA minimum volume and indexed LA maximum volume were significantly greater in men than in women (P<0.05). All the subjects had LV ejection fractions within the normal range. Conclusions It is clinically feasible to study diastolic flow and LV filling with CMR. CMR detected diastolic dysfunction in asymptomatic men and women. Key Points • CMR imaging offers new possibilities in assessing left ventricular diastolic function.• The prevalence of diastolic dysfunction is higher in men than in women.• The prevalence of some diastolic dysfunction in a normal population is 24 %.

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“…However, despite these methodological developments and the recent technological improvements in PC-CMR sequences, the use of CMR in clinical evaluation of diastolic function remains limited because of the lack of automated methods designed for the analysis of PC images. Indeed, most of the PC-CMR studies previously presented in the literature were based on manual positioning of ROIs on each phase of the cardiac cycle [8][9][10][11][12][13][14][15]. This manual positioning is time-consuming [30] and subjective [8], leading to inter-and intra-operator variability, as reflected by the previously reported variability coefficient of 10% [31].…”

Section: Discussionmentioning

confidence: 99%

“…Although CMR is known as the modality of choice for the evaluation of global LV function [20,21], systolic function and myocardial viability [22,23], Doppler echocardiography remains the clinical reference for the evaluationo fd i a s t o l i cd y s f u n c t i o n [4,24,25]. Several CMR studies, based on volume variation curves extracted from cine images [26][27][28][29] or on velocity and flow rate curves extracted from PC images [8][9][10][11][12][13][14][15], reported capabilities of this modality for the assessment of diastolic function. However, despite these methodological developments and the recent technological improvements in PC-CMR sequences, the use of CMR in clinical evaluation of diastolic function remains limited because of the lack of automated methods designed for the analysis of PC images.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, several studies demonstrated the usefulness of phase-contrast (PC) CMR in the measurement of some of the aforementioned conventional diastolic parameters [6][7][8]. However, these analyses were mostly based on manual positioning of regions of interest (ROIs) within the transmitral flow area or the myocardium on multiple phases [8][9][10][11][12][13][14][15]. This manual positioning of ROIs is time-consuming and operator-dependent.…”

Section: Introductionmentioning

confidence: 99%

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Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: A practical approach

Cited by 134 publications

References 26 publications

Assessment of left ventricular diastolic function by mr: what radiologists should know

Assessment of left ventricular diastolic function by mr: what radiologists should know

Cardiovascular magnetic resonance imaging assessment of diastolic dysfunction in a population without heart disease: a gender-based study

Doppler Echocardiography

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