Key result
3D mitral annulus sweep volumes generated by semi-automated tracking in CMR images effectively identified patients with diastolic dysfunction, demonstrating a significantly lower PSRE/PSRA ratio (0.9 vs 1.82) compared to those with normal function.
Why the study?
Does 3D volume tracking of the mitral annulus with CMR accurately identify diastolic dysfunction compared to TTE in patients with normal ejection fraction?
Cross-Sectional (n=124)
No
Does 3D volume tracking of the mitral annulus with CMR accurately identify diastolic dysfunction compared to TTE in patients with normal ejection fraction?
Absolute Event Rate: 0.9% vs 1.82%
p-value: p=<0.001
3D volume tracking of the mitral annulus using routine cine-CMR provides diastolic parameters that accurately identify diastolic dysfunction compared to standard echocardiography.
May support CMR diastolic assessment in normal-EF patients; hypothesis-generating and requires prospective TTE validation before adoption.
BACKGROUND: Measurement of mitral annulus (MA) dynamics is an important component of the evaluation of left ventricular (LV) diastolic function; MA velocities are commonly measured using tissue Doppler imaging (TDI). This study aimed to examine the clinical potential of a semi-automated cardiovascular magnetic resonance (CMR) technique for quantifying global LV diastolic function, using 3D volume tracking of the MA with conventional cine-CMR images. METHODS: 124 consecutive patients with normal ejection fraction underwent both clinically indicated transthoracic echocardiography (TTE) and CMR within 2 months. Interpolated 3D reconstruction of the MA over time was performed with semi-automated atrioventricular junction (AVJ) tracking in long-axis cine-CMR images, producing an MA sweep volume over the cardiac cycle. CMR-based diastolic function was evaluated, using the following parameters: peak volume sweep rates in early diastole (PSRE) and atrial systole (PSRA), PSRE/PSRA ratio, deceleration time of sweep volume (DTSV), and 50% diastolic sweep volume recovery time (DSVRT50); these were compared with TTE diastolic measurements. RESULTS: Patients with TTE-based diastolic dysfunction (n = 62) showed significantly different normalized MA sweep volume profiles compared to those with TTE-based normal diastolic function (n = 62), including a lower PSRE (5.25 ± 1.38 s-1 vs. 7.72 ± 1.7 s-1), a higher PSRA (6.56 ± 1.99 s-1 vs. 4.67 ± 1.38 s-1), a lower PSRE/PSRA ratio (0.9 ± 0.44 vs. 1.82 ± 0.69), a longer DTSV (144 ± 55 ms vs. 96 ± 37 ms), and a longer DSVRT50 (25.0 ± 11.0% vs. 15.6 ± 4.0%) (all p < 0.05). CMR diastolic parameters were independent predictors of TTE-based diastolic dysfunction after adjusting for left ventricular hypertrophy, hypertension, and coronary artery disease. Good correlations were observed between CMR PSRE/PSRA and early-to-late diastolic annular velocity ratios (e'/a') measured by TDI (r = 0.756 to 0.828, p < 0.001). CONCLUSIONS: 3D MA sweep volumes generated by semi-automated AVJ tracking in routinely acquired CMR images yielded diastolic parameters that were effective in identifying patients with diastolic dysfunction when correlated with TTE-based variables.
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Wu et al. (2014) conducted a cross-sectional in Diastolic dysfunction (n=124). 3D volume tracking of the mitral annulus with CMR vs. Tissue Doppler imaging (TTE) was evaluated on PSRE/PSRA ratio (p=<0.001). 3D mitral annulus sweep volumes generated by semi-automated tracking in CMR images effectively identified patients with diastolic dysfunction, demonstrating a significantly lower PSRE/PSRA ratio (0.9 vs 1.82) compared to those with normal function.
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