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First-pass perfusion cardiovascular magnetic resonance parameters as surrogate markers for left ventricular diastolic dysfunction: a validation against cardiac catheterization

  • Cardiac
  • Published:
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Abstract

Objectives

The non-invasive assessment of left ventricular (LV) diastolic dysfunction remains a challenge. The role of first-pass perfusion cardiac magnetic resonance (CMR) parameters in quantitative hemodynamic analyses has been reported. We therefore aimed to validate the diagnostic ability and accuracy of such parameters against cardiac catheterization for LV diastolic dysfunction in patients with left heart disease (LHD).

Methods

We retrospectively enrolled 77 LHD patients who underwent CMR imaging and cardiac catheterization. LV diastolic dysfunction was defined as pulmonary capillary wedge pressure (PCWP) or LV end-diastolic pressure (LVEDP) > 12 mmHg on catheterization. On first-pass perfusion CMR imaging, pulmonary transit time (PTT) was measured as the time for blood to pass from the left ventricle to the right ventricle (RV) through the pulmonary vasculature. Pulmonary transit beat (PTB) was the number of cardiac cycles within the interval, and pulmonary blood volume indexed to body surface area (PBVi) was the product of PTB and RV stroke volume index (RVSVi).

Results

Of the 77 LHD patients, 53 (68.83%) were found to have LV diastolic dysfunction, and showed significantly higher PTTc, PTB, and PBVi (p < 0.05) compared with those without. In multivariate analyses, only PTTc and PTB were identified as independent predictors of LV diastolic dysfunction (p < 0.05). With an optimal cutoff of 11.9 s, PTTc yielded the best diagnostic performance for LV diastolic dysfunction (area under the curve = 0.83, p < 0.001).

Conclusions

PTTc may represent a non-invasive quantitative surrogate marker for the detection and assessment of diastolic dysfunction in LHD patients.

Key Points

• PTTc yielded the best diagnostic accuracy for diastolic dysfunction, with an optimal cutoff of 11.9 s, and a specificity of 100%.

• PTTc and PTB were found to be independent predictors of LV diastolic dysfunction across different multivariate models with high reproducibility.

• PTTc is a promising non-invasive surrogate marker for the detection and assessment of diastolic dysfunction in LHD patients.

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Abbreviations

CMR:

Cardiac magnetic resonance

CoV:

Coefficient of variation

DBP:

Diastolic blood pressure

dPAP:

Diastolic pulmonary artery pressure

HF:

Heart failure

ICC:

Intra-class correlation coefficient

LHD:

Left heart disease

LV:

Left ventricular

LVEDP:

LV end-diastolic pressure

mPAP:

Mean pulmonary artery pressure

mRAP:

Mean right atrial pressure

NYHA:

New York Heart Association

PBVi:

Pulmonary blood volume indexed to body surface area

PCWP:

Pulmonary capillary wedge pressure

PTB:

Pulmonary transit beats

PTT:

Pulmonary transit time

ROC:

Receiver operating characteristic

ROI:

Region of interest

RV:

Right ventricular

RVSVi:

RV stroke volume index

SBP:

Systolic blood pressure

SI:

Signal intensity

sPAP:

Systolic pulmonary artery pressure

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Funding

This work was supported by the 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (Grant No. ZYJC18013 and Grant No. Z2018A08)

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Author notes

  1. Xinli Guo, Chao Gong and Rizhen Song contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China

    Xinli Guo, Chao Gong, Rizhen Song & Yucheng Chen

  2. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China

    Ke Wan

  3. Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA, USA

    Yuchi Han

Authors
  1. Xinli Guo
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  2. Chao Gong
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  5. Yuchi Han
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  6. Yucheng Chen
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Corresponding author

Correspondence to Yucheng Chen.

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The scientific guarantor of this publication is Yucheng Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Guo, X., Gong, C., Song, R. et al. First-pass perfusion cardiovascular magnetic resonance parameters as surrogate markers for left ventricular diastolic dysfunction: a validation against cardiac catheterization. Eur Radiol 32, 8131–8139 (2022). https://doi.org/10.1007/s00330-022-08938-6

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  • DOI: https://doi.org/10.1007/s00330-022-08938-6

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