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Evaluating biventricular diastolic function using cardiovascular magnetic resonance 4d-flow derived E/e'.

Leonard Grob1, Jacopo Soldini1, Stephanie Keser1

  • 1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland.

European Heart Journal. Imaging Methods and Practice
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PubMed
Summary

Cardiovascular magnetic resonance (CMR) imaging with 4D flow can assess biventricular diastolic function by calculating 4D-E/e' and identifying previously unrecognized diastolic abnormalities in patients with cardiovascular disease.

Keywords:
4D flowcardiovascular magnetic resonancediastolic dysfunctione/e’myocardial strainright ventricle

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Biophysics

Background:

  • Cardiovascular magnetic resonance (CMR) is crucial for heart disease characterization but limited in assessing diastolic dysfunction (DD).
  • 4D flow CMR allows quantification of transvalvular blood flow.
  • Standard cine CMR images can quantify biventricular tissue relaxation via annular tissue velocity and strain.

Purpose of the Study:

  • To investigate the utility of 4D-CMR-derived E/e' in evaluating biventricular diastolic function.
  • To compare 4D-E/e' with echocardiography to establish cutoffs for detecting unknown DD.
  • To assess the feasibility of biventricular 4D-E/e' across different tissue velocity methods.

Main Methods:

  • Quantified diastolic transvalvular flow (4D-E) using 4D flow CMR in 75 controls and 57 cardiovascular disease patients.
  • Assessed tissue velocity (e') using cine-derived mitral/tricuspid annular velocity, longitudinal strain rate, and strain velocity.
  • Calculated biventricular 4D-E/e' and compared it with echocardiography-based DD grading.

Main Results:

  • Biventricular 4D-E/e' was feasible and significantly higher in patients than controls (P < 0.05).
  • 4D-E/e' using annular velocity best distinguished patients with echocardiography-confirmed DD (left: AUC = 0.90 ± 0.05; right: AUC = 0.81 ± 0.07).
  • 71% of patients without prior diastolic assessment showed abnormal left ventricular diastolic function and 61% abnormal right ventricular diastolic function based on 4D-E/e' cutoffs.

Conclusions:

  • 4D-E/e' is a feasible method for biventricular diastolic function assessment, integrating transvalvular flow and tissue velocity.
  • CMR identified previously unrecognized biventricular diastolic abnormalities in cardiovascular disease patients.
  • 4D-E/e' may serve as a valuable tool for early detection of diastolic dysfunction and guide further testing.