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Published on: June 23, 2015
Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with
Charlotte Gimpel1, Bernd A Jung2, Sabine Jung3
1Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Mathildenstr. 1, 79106,, Freiburg, Germany. Charlotte.Gimpel@uniklinik-freiburg.de.
Insights
Magnetic Resonance Imaging (MRI) tissue phase mapping (TPM) is feasible in children with chronic kidney disease (CKD). This advanced imaging technique reveals reduced diastolic function in pediatric CKD patients, indicating early myocardial changes.
Area of Science:
- Cardiovascular Imaging
- Pediatric Nephrology
- Medical Diagnostics
Background:
- Children with chronic kidney disease (CKD) often exhibit functional cardiac abnormalities.
- Early detection of cardiac dysfunction in pediatric CKD is crucial for timely intervention.
- Conventional echocardiography may not always capture subtle functional changes.
Purpose of the Study:
- To evaluate the feasibility of Magnetic Resonance Imaging (MRI) tissue phase mapping (TPM) in pediatric patients.
- To assess regional left ventricular (LV) wall motion and function in children with CKD using TPM.
- To identify early signs of myocardial dysfunction in pediatric CKD before structural changes occur.
Main Methods:
- Twenty pediatric patients with CKD (pre- or post-renal transplantation) and 12 healthy controls underwent cardiac MRI.
- Tissue phase mapping (TPM) was employed to quantify myocardial velocities in the long-axis (Vz) and short-axis (Vr) directions.
- LV function was assessed at base, mid, and apex levels, with comparisons to echocardiography data where available.
Main Results:
- MRI tissue phase mapping (TPM) proved feasible in children and adolescents aged 8-20 years.
- Pediatric CKD patients demonstrated significantly reduced peak diastolic long-axis (Vz) and short-axis (Vr) velocities compared to controls.
- These reductions in myocardial velocities indicate impaired early diastolic filling, even in the absence of LV hypertrophy or echocardiographic diastolic dysfunction.
Conclusions:
- Tissue phase mapping (TPM) is a viable and effective imaging modality for assessing cardiac function in pediatric populations.
- Children with chronic kidney disease exhibit subclinical impairments in left ventricular diastolic function detectable by TPM.
- TPM can identify early, functional myocardial changes associated with chronic kidney disease, preceding structural abnormalities.
Background:
Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease.
Objective:
To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease.
Materials And Methods:
Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle.
Results:
Patients and controls (age: 8 years-20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (VE), late diastolic (VA) and peak systolic (VS) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vzbase -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vzmid -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vzapex -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vrbase -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vrmid -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vrapex -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05).
Conclusion:
Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs.
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