4D-Flow CMR derived early diastolic vorticity was significantly reduced in COPD patients compared with controls (P<0.0001), serving as a sensitive marker of early left ventricular diastolic dysfunction.
Case-Control (n=26)
Is 4D-Flow CMR-derived left ventricular vorticity a more sensitive marker of early diastolic dysfunction than standard echocardiography in patients with mild-to-moderate COPD?
4D-Flow CMR-derived diastolic vorticity can detect early left ventricular diastolic dysfunction in mild-to-moderate COPD patients before standard echocardiographic changes appear.
p-value: p=<0.0001
Aims: To investigate the possibility that vorticity assessed by four-dimensional flow cardiac magnetic resonance (4D-Flow CMR) in the left ventricle of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is a potential marker of early LV diastolic dysfunction (LVDD) and more sensitive than standard echocardiography, and whether changes in vorticity are associated with quantitative computed tomography (CT) and clinical markers of COPD, and right ventricular (RV) echocardiographic markers indicative of ventricular interdependency. Methods and results: Sixteen COPD patients with presumptive LVDD and 10 controls underwent same-day 4D-Flow CMR and Doppler echocardiography to quantify early and late diastolic vorticity as well as standard evaluation for LVDD. Furthermore, all patients underwent detailed CT analysis for COPD markers including percent emphysema and air trapping. The 4D-Flow CMR derived diastolic vorticity measures were correlated with CT measures, standard clinical and CMR markers, and echocardiographic diastolic RV metrics. Early diastolic vorticity was significantly reduced in COPD patients (P < 0.0001) with normal left ventricular (LV) mass, geometry, systolic function, and no or mild signs of Doppler LVDD when compared with controls. Vorticity significantly differentiated COPD patients without echocardiographic signs of LVDD (n = 11) from controls (P < 0.0001), and from COPD patients with stage I LVDD (n = 5) (P < 0.0180). Vorticity markers significantly correlated with CT computed measures, CMR-derived RV ejection fraction, echocardiographic RV diastolic metrics, and 6-minute walk test. Conclusion: 4D-Flow CMR derived diastolic vorticity is reduced in patients with mild-to-moderate COPD and no or mild signs of LVDD, implying early perturbations in the LV flow domain preceding more obvious mechanical changes (i.e. stiffening and dilation). Furthermore, reduced LV vorticity appears to be driven by COPD induced changes in lung tissue and parallel RV dysfunction.
Schäfer et al. (Fri,) conducted a case-control in Mild-to-moderate chronic obstructive pulmonary disease (COPD) (n=26). 4D-Flow CMR vs. Controls was evaluated on Early diastolic vorticity (p=<0.0001). 4D-Flow CMR derived early diastolic vorticity was significantly reduced in COPD patients compared with controls (P<0.0001), serving as a sensitive marker of early left ventricular diastolic dysfunction.