4D flow MRI-based grading of left ventricular diastolic dysfunction: a validation study against echocardiography.

Area of Science:

• Cardiovascular Imaging
• Medical Physics
• Diagnostic Radiology

Background:

• Left ventricular diastolic dysfunction (LVDD) assessment is crucial for managing heart failure.
• Echocardiography is the standard for LVDD grading, but limitations exist.
• Cardiac MRI offers advanced visualization but lacks established grading protocols for LVDD.

Purpose of the Study:

• To evaluate the feasibility and accuracy of grading LVDD using 4D flow MRI.
• To compare 4D flow MRI grading parameters with established echocardiographic methods.
• To determine the agreement between 4D flow MRI and echocardiography in LVDD classification.

Main Methods:

• Prospective recruitment of 94 participants for 3T 4D flow MRI and echocardiography.
• LVDD grading using the 2016 ASE/EACVI multiparametric approach via echocardiography.
• Evaluation of volumetric and echo-equivalent peak velocity parameters from 4D flow MRI data.
• Utilized duration of vortical blood flow in the pulmonary artery (t_vortex) as a surrogate for tricuspid regurgitant velocity.

Main Results:

• Strong to very strong correlations (r=0.75-0.92) observed between 4D flow MRI and echocardiographic grading parameters.
• Volumetric parameters from 4D flow MRI showed some biases compared to echocardiography.
• After bias adjustment and incorporating t_vortex, nearly perfect agreement (weighted kappa=0.84) in LVDD grading was achieved.
• No significant over- or underestimation of LVDD grades by 4D flow MRI was found.

Conclusions:

• Single-session 4D flow MRI enables multiparametric grading of LVDD.
• The method demonstrates feasibility and nearly perfect agreement with echocardiography.
• 4D flow MRI is a viable alternative to echocardiography for LVDD assessment in selected patients undergoing cardiac MRI.