Key result
MR 4D flow imaging using the max-velocity-method evaluated transmitral peak velocities without significant bias compared to echocardiography (p=0.13 for E; p=0.07 for E/A).
Why the study?
Agreement between different evaluation methods of MR 4D flow-derived diastolic transmitral and myocardial peak velocities and their ratios compared with echocardiography had not been fully determined.
Does non-contrast 3 T MR 4D flow imaging accurately measure diastolic transmitral and myocardial peak velocities compared to echocardiography in subjects without symptoms of cardiovascular disease?
Observational (n=60)
Does non-contrast 3 T MR 4D flow imaging accurately measure diastolic transmitral and myocardial peak velocities compared to echocardiography in subjects without symptoms of cardiovascular disease?
Effect estimate: r = 0.65-0.86
p-value: p=0.13 for E bias
MR 4D flow imaging using the max-velocity-method allows accurate evaluation of LV diastolic function parameters without significant bias compared to standard echocardiography.
Supports 4D flow MR for diastolic assessment in asymptomatic subjects; leaves open prospective validation before clinical adoption.
PURPOSE: To compare agreement of different evaluation methods of magnetic resonance (MR) 4D flow-derived diastolic transmitral and myocardial peak velocities as well as their ratios, using echocardiography as reference. METHODS: In this prospective study, 60 subjects without symptoms of cardiovascular disease underwent echocardiography and non-contrast 3 T MR 4D flow imaging of the heart. Early- (E) and late-diastolic (A) transmitral peak filling velocities were evaluated from 4D flow data using three different strategies: 1) at the mitral valve tips in short-axis orientation (SA-method), 2) between the mitral valve tips in 4-chamber orientation (4-chamber-method), and 3) as maximal velocities in the transmitral inflow volume (max-velocity-method). Septal, lateral and average early-diastolic myocardial peak velocities (e') were derived from the myocardial tissue in the vicinity of the mitral valve. 4D flow parameters were compared with echocardiography by correlation and Bland-Altman analysis. RESULTS: All 4D flow-derived E, A and E/A values correlated with echocardiography (r = 0.65-0.73, 0.75-0.83 and 0.74-0.86, respectively). While the SA- and 4-chamber-methods substantially underestimated E and A compared to echocardiography (p < 0.001), the max-velocity-method provided E (p = 0.13) and E/A (p = 0.07) without significant bias. Septal, lateral and average e' from 4D flow as well as the max-velocity-method-derived E/e' correlated with echocardiographic measurements (r = 0.64-0.81) and showed no significant bias (p = 0.26-0.54). CONCLUSION: MR 4D flow imaging allows precise and accurate evaluation of transmitral and myocardial peak velocities for characterization of LV diastolic function without significant bias to echocardiography, when transmitral velocities are assessed from the transmitral inflow volume. This enables the use of validated echocardiography threshold values.
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Reiter et al. (2023) conducted an observational in Without symptoms of cardiovascular disease (n=60). MR 4D flow imaging vs. Echocardiography was evaluated on Agreement of early- (E) and late-diastolic (A) transmitral peak filling velocities and E/A ratios (r = 0.65-0.86, p=0.13 for E bias). MR 4D flow imaging using the max-velocity-method evaluated transmitral peak velocities without significant bias compared to echocardiography (p=0.13 for E; p=0.07 for E/A).
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