Automated cine-CMR segmentation revealed that prolonged diastolic volume recovery was associated with grade 1 diastolic dysfunction (OR 2.79), while high peak filling rate was associated with grade 3.
Observational (n=115)
Single-blind
No
Can automated cine-CMR segmentation discern left ventricular filling changes associated with increasing severity of echocardiography-evidenced diastolic dysfunction in post-MI patients?
Automated cine-CMR segmentation can effectively identify left ventricular filling changes corresponding to different grades of diastolic dysfunction, offering a reproducible method to assess diastolic function.
Effect estimate: OR 2.79 (95% CI 1.65-4.05)
p-value: p=0.001
OBJECTIVES: To examine relationships between severity of echocardiography (echo) -evidenced diastolic dysfunction (DD) and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR). BACKGROUND: Cine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Automated segmentation (LV-METRIC) yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD. METHODS: 115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR), time to peak filling rate (TPFR), and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume). Echo was the reference for DD. RESULTS: LV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (< or = 1% inter-reader differences) and required minimal processing time (175 +/- 34 images/exam, 2:09 +/- 0:51 minutes). CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p < 0.001). PFR by CMR increased with DD grade, similar to E/e' (p < 0.001). Prolonged DVR80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%). The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001) with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06), whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02) DD. CONCLUSIONS: Automated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged filling intervals whereas restrictive filling is characterized by increased filling rates.
Mendoza et al. (Tue,) conducted a observational in Post-myocardial infarction with diastolic dysfunction (n=115). Automated cine-CMR segmentation (LV-METRIC) vs. Echocardiography was evaluated on Association of prolonged diastolic volume recovery (DVR80) with grade 1 diastolic dysfunction (OR 2.79, 95% CI 1.65-4.05, p=0.001). Automated cine-CMR segmentation revealed that prolonged diastolic volume recovery was associated with grade 1 diastolic dysfunction (OR 2.79), while high peak filling rate was associated with grade 3.
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