Why the study?
Non-invasive assessment of LV diastolic and systolic function is needed to better understand physiological abnormalities in HF, prompting evaluation of an MRI-based method to calculate IVPDs across HF subtypes.
Does cardiac MRI-based estimation of intraventricular pressure differences reveal distinct physiological patterns between subjects without heart failure, with HFrEF, and with HFpEF?
Does cardiac MRI-based estimation of intraventricular pressure differences reveal distinct physiological patterns between subjects without heart failure, with HFrEF, and with HFpEF?
Cardiac MRI reveals distinct patterns of diastolic intraventricular pressure differences in HFpEF compared to HFrEF and normal subjects, highlighting differences in the underlying mechanisms of diastolic dysfunction.
Objective: Non-invasive assessment of left ventricular (LV) diastolic and systolic function is important to better understand physiological abnormalities in heart failure (HF). The spatiotemporal pattern of LV blood flow velocities during systole and diastole can be used to estimate intraventricular pressure differences (IVPDs). We aimed to demonstrate the feasibility of an MRI-based method to calculate systolic and diastolic IVPDs in subjects without heart failure (No-HF), and with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Methods: We studied 159 subjects without HF, 47 subjects with HFrEF and 32 subjects with HFpEF. Diastolic and systolic intraventricular flow was measured using two-dimensional in-plane phase-contrast MRI. The Euler equation was solved to compute IVPDs in diastole (mitral base to apex) and systole (apex to LV outflow tract). Results: Subjects with HFpEF demonstrated a higher magnitude of the early diastolic reversal of IVPDs (-1.30 mm Hg) compared with the No-HF group (-0.78 mm Hg) and the HFrEF group (-0.75 mm Hg; analysis of variance p=0.01). These differences persisted after adjustment for clinical variables, Doppler-echocardiographic parameters of diastolic filling and measures of LV structure (No-HF=-0.72; HFrEF=-0.87; HFpEF=-1.52 mm Hg; p=0.006). No significant differences in systolic IVPDs were found in adjusted models. IVPD parameters demonstrated only weak correlations with standard Doppler-echocardiographic parameters. Conclusions: Our findings suggest distinct patterns of systolic and diastolic IVPDs in HFpEF and HFrEF, implying differences in the nature of diastolic dysfunction between the HF subtypes.
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Londono‐Hoyos et al. (2019) studied this question.
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