Diastolic dysfunction evaluated by cardiac magnetic resonance: the value of the combined assessment of atrial and ventricular function.
Giovanni Donato Aquaro, Fausto Pizzino, Anna Terrizzi, Scipione Carerj, Bijoy K Khandheria, Gianluca Di Bella
Author Information
Giovanni Donato Aquaro: Fondazione G. Monasterio CNR-Toscana, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy. aquaro@ftgm.it.
Fausto Pizzino: Scuola Superiore Sant'Anna di Studi Universitari e di Perfezionamento, Pisa, Italy.
Anna Terrizzi: Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Messina, Italy.
Scipione Carerj: Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Messina, Italy.
Bijoy K Khandheria: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
Gianluca Di Bella: Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Messina, Italy.
OBJECTIVES: We sought to evaluate the role of cardiac magnetic resonance imaging (CMR) in the evaluation of diastolic function by a combined assessment of left ventricular (LV) and left atrial (LA) function in a cohort of subjects with various degrees of diastolic dysfunction (DD) detected by echocardiography. METHODS: Forty patients with different stages of DD and 18 healthy controls underwent CMR. Short-axis cine steady-state free precession images covering the entire LA and LV were acquired. Parameters of diastolic function were measured by the analysis of the LV and LA volume/time (V/t) curves and the respective derivative dV/dt curves. RESULTS: At receiver operating characteristic (ROC) curve analysis, the peak of emptying rate A indexed by the LV filling volume with a cut-off of 3.8 was able to detect patients with grade I DD from other groups (area under the curve [AUC] 0.975, 95% confidence interval [CI] 0.86-1). ROC analysis showed that LA ejection fraction with a cut-off of ≤36% was able to distinguish controls and grade I DD patients from those with grade II and grade III DD (AUC 0.996, 95% CI 0.92-1, p < 0.001). The isovolumetric pulmonary vein transit ratio with a cut-off of 2.4 allowed class III DD to be distinguished from other groups (AUC 1.0, 95%CI 0.93-1, p < 0.001). CONCLUSIONS: Analysis of LV and LA V/t curves by CMR may be useful for the evaluation of DD. KEY POINTS: • Combined atrial and ventricular volume/time curves allow evaluation of diastolic function. • Atrial emptying fraction allows distinction between impaired relaxation and restrictive/pseudo-normal filling. • Isovolumetric pulmonary vein transit ratio allows distinction between restrictive and pseudo-normal filling.
