Diagnosis of Left Ventricular Diastolic Dysfunction Using Cardiac Magnetic Resonance Imaging: Comparison of Volume-Time Curves Derived from Long- and Short-Axis Cine Steady-State Free Precession Datasets

Abstract

Purpose To evaluate the diagnostic performance of diastolic function parameters derived from long-axis (LAX) planimetry compared with short-axis (SAX) volumetry in cardiac magnetic resonance imaging.

Materials and Methods Cine steady-state free precession (SSFP) datasets of 15 healthy participants (8 young and 7 middle aged) and 25 patients with echocardiographically proven diastolic dysfunction (9 mild, 9 moderate, and 7 severe) were retrospectively included. Volume-time curves for assessing left ventricular (LV) function were obtained by manually contouring the LV endocardial borders in SAX and LAX datasets. The time needed for contouring was recorded for each dataset. The following LV parameters were determined: end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), myocardial mass (MM), time to peak filling rate (TPFR), normalized peak filling rate (nPFR), and the ratio of early to late peak filling rate (E/A ratio). A Wilcoxon signed-rank test was used to compare subgroups based on age and severity of diastolic dysfunction for statistical differences. Intraclass correlation coefficients were used to assess intermethod and interobserver reliability.

Results Accuracy for the diagnosis of diastolic dysfunction was highest for E/A (mild diastolic dysfunction) and nPFR (any stage of diastolic dysfunction) derived from LAX datasets (E/A: area under the curve (AUC) = 0.97, sensitivity of 68 % and specificity of 100 %; nPFR: AUC = 0.84, sensitivity of 84 % and specificity of 80 %). Diastolic parameters showed a moderate to good intraclass correlation between both methods. The mean differences in EDV, ESV, EF, and MM were 5.3 ml, 1.9 ml, 3.5 %, and 11 g, respectively (each p < 0.001). Significantly less time was needed to derive volume-time curves from LAX images (median 14:45 min, interquartile range 14:15–15:53 min versus median 29:25 min, interquartile range 28:12–32:22 min; p = 0.001). The interobserver reliability was generally good to excellent.

Conclusion Diastolic function parameters derived from left ventricular LAX planimetry have high diagnostic performance and can be obtained in significantly less time compared with SAX volumetry. These findings may pave the way for routine use of LAX planimetry in the clinical diagnosis of diastolic dysfunction.

Key points: 

• Diastolic function parameters derived from long-axis datasets have high diagnostic performance.

• Generation of volume-time curves using long-axis datasets requires significantly less time.

• This time savings may allow use of cardiac MRI for the diagnosis of diastolic dysfunction in the clinical routine.

Citation Format

• Schaafs LA, Wyschkon S, Elgeti M et al. Diagnosis of Left Ventricular Diastolic Dysfunction Using Cardiac Magnetic Resonance Imaging: Comparison of Volume-Time Curves Derived from Long- and Short-Axis Cine Steady-State Free Precession Datasets. Fortschr Röntgenstr 2020; 192: 764 – 775

Zusammenfassung

Ziel Vergleich der diagnostischen Genauigkeit von diastolischen Funktionsparametern in der kardialen MRT, die mittels Langachsen (LAX)-Planimetrie bzw. Kurzachsen (SAX) -Volumetrie an Patienten mit diastolischer Dysfunktion erhoben wurden.

Material und Methoden Cine-steady-state-free-precession (SSFP)-Datensätze von 15 gesunden Teilnehmern (8 junge Teilnehmer, 7 Teilnehmer mittleren Alters) sowie 25 Patienten mit echokardiografisch gesicherter diastolischer Dysfunktion (9 mild, 9 moderat und 7 schwer) wurden retrospektiv ausgewertet. Volumen-Zeit-Kurven zur Bewertung der linksventrikulären Funktion wurden nach manuellem Einzeichnen der Endo- bzw. Epikardkontur auf SAX- und LAX-Datensätzen berechnet. Die für jeden Datensatz benötigte Zeit wurde gemessen. Im Anschluss wurden enddiastolisches (EDV) und endsystolisches Volumen (ESV), Ejektionsfraktion (EF), myokardiale Masse (MM), „time-to-peak-fillin-rate“ (TPFR), normalisierte „peak-filling-rate“ (nPFR) und E/A-Verhältnis (E/A) für den linken Ventrikel bestimmt. Unterschiede der Messergebnisse wurden mittels Wilcoxon-Vorzeichen-Rang-Test geprüft. Die Reliabilität zwischen den Auswertern und zwischen beiden Methoden wurde mittels Intra-Klassen-Korrelation gemessen.

Ergebnisse Die höchste diagnostische Genauigkeit wurde mit E/A (Diagnose einer milden diastolischen Dysfunktion) und nPFR (Diagnose einer diastolischen Dysfunktion unabhängig vom Stadium), jeweils generiert aus LAX-Datensätzen, erreicht (E/A: Fläche unter der Kurve = 0,97, 68 % Sensitivität und 100 % Spezifität; nPFR: Fläche unter der Kurve = 0,84, 84 % Sensitivität und 80 % Spezifität). Die diastolischen Funktionsparameter wiesen im Vergleich eine moderate bis gute Intra-Klassen-Korrelation zwischen beiden Methoden auf. Die mittlere Differenz für EDV, ESV, EF und MM betrug 5,3 ml, 1,9 ml, 3,5 % beziehungsweise 11 g (p < 0,001). Die für die Erstellung von Volumen-Zeit-Kurven benötigte Zeit war signifikant kürzer bei der Verwendung von LAX-Datensätzen (Median 14:45 min, Interquartilsabstand 14:15–15:53 min versus median 29:25 min, Interquartilsabstand 28:12–32:22 min; p = 0,001). Die Reliabilität zwischen beiden Auswertern war gut bis exzellent.

Schlussfolgerung Die Planimetrie des linken Ventrikels auf Langachsen ergab diastolische Funktionsparameter mit einer hohen diagnostischen Genauigkeit und kann im Vergleich zur Volumetrie in deutlich kürzerer Zeit durchgeführt werden. Diese Erkenntnisse könnten den Einsatz der MRT zur Routinediagnostik der diastolischen Dysfunktion ermöglichen.

Kernaussagen: 

• Mittels Langachsen-Planimetrie berechnete diastolische Funktionsparameter weisen eine hohe diagnostische Aussagekraft auf.

• Die Erstellung von Volumen-Zeit-Kurven durch Auswertung von Langachsen-Datensätzen benötigt deutlich weniger Zeit.

• Diese Zeitersparnis könnte den Einsatz der MRT zur Routinediagnostik der diastolischen Dysfunktion ermöglichen.

Key words

cardiac function - magnetic resonance imaging - diastolic dysfunction - long axis - short axis

Publication History

Received: 11 April 2019

Accepted: 16 January 2020

Article published online:
27 February 2020

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