Evaluation of left ventricular diastolic function with cardiac MR imaging

Assessment of left ventricular (LV) function with cardiac magnetic resonance (MR) imaging is often limited to evaluation of systolic function, including analysis of regional wall motion, measurement of mass and volume, and estimation of ejection fraction. However, diastolic dysfunction is present in various heart diseases, particularly in heart failure with preserved ejection fraction, which is increasingly prevalent and is associated with a poor prognosis. In daily practice, the assessment of diastolic function is mainly performed with transthoracic echocardiography. Evaluation of diastolic function with cardiac MR imaging is seldom performed in clinical practice. However, basic assessment of LV relaxation and stiffness abnormalities can be achieved with MR imaging by using a combination of left atrium size measurement and phase-contrast evaluation of transmitral flow. In addition, assessment of pulmonary venous flow and the LV filling curve can also be performed. Furthermore, MR imaging with late gadolinium enhancement sequences provides insight into the extent of myocardial fibrosis, which strongly influences LV stiffness. Finally, phase-contrast evaluation of tissue velocities, myocardial tagging, MR spectroscopy, and MR elastography are promising tools for a better understanding of LV diastolic function but require further evaluation.