Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive...

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Techniques

Background:

• Constrictive pericarditis (CP) diagnosis relies on identifying constrictive hemodynamics, often with pericardial thickening.
• Current cardiac magnetic resonance (CMR) primarily offers morphological assessment of the pericardium.

Purpose of the Study:

• Evaluate a novel real-time phase contrast (RT-PC) CMR technique for assessing mitral and tricuspid valve inflow.
• Determine if RT-PC can reveal discordant respirophasic changes indicative of CP hemodynamics.

Main Methods:

• Sixteen patients with suspected CP and 10 controls underwent simultaneous mitral and tricuspid valve inflow velocity measurements using RT-PC CMR over 10 seconds of breathing.
• CP diagnosis was confirmed through comprehensive clinical, imaging, and invasive methods.

Main Results:

• All 10 CP patients exhibited discordant respirophasic changes in atrioventricular valve inflow velocities.
• Mitral and tricuspid valve inflow velocity variations were significantly higher in CP patients (46% and 60%) compared to non-CP patients (16% and 24%) and controls (17% and 31%).
• RT-PC demonstrated high sensitivity and specificity (100% for mitral inflow variation >25%) in detecting CP physiology.

Conclusions:

• RT-PC CMR can noninvasively identify characteristic accentuated and discordant respirophasic changes in mitral and tricuspid valve inflow velocities associated with CP.
• Integrating RT-PC into CMR protocols enhances diagnostic capabilities for CP by providing crucial hemodynamic evidence.