Quick Fire Session
SCMR 22nd Annual Scientific Sessions
Joao Ramos, MD
PhD-Student
Karolinska Institutet
Alexander Fyrdahl, MSc
Medical physicist
Karolinska University Hospital and Karolinska Institutet
Björn Wieslander, MD
Post-doc
Karolinska Institutet
Simon Thalén, MD
PhD Student
Karolinska Institutet
Gert Reiter, PhD
MR Physicist
Siemens Healthcare Diagnostics GmbH
Ursula Reiter, PhD
MR Physicist
Medical University of Graz
Ning Jin, PhD
PhD
Siemens Medical Solutions USA, Inc.
Eva Maret, MD, PhD
Head
Department of Clinical Physiology, Karolinska University Hospital
Maria Eriksson, MD
Associate Professor
Karolinska Institutet
Kenneth Caidahl, MD, PhD
Professor
Karolinska Institutet
Peder Sorensson, MD, PhD
Senior Consultant
Karolinska Institutet
Andreas Sigfridsson, PhD
MR Scientist
Karolinska Institute
Martin Ugander, MD, PhD
Associate Professor
Karolinska Institutet
Background: The assessment of left ventricular diastolic dysfunction (DD) with echocardiography is associated with morbidity and mortality. The parameters used to diagnose and grade DD are measures of diastolic velocities in the blood flow across the mitral valve (E and A), diastolic velocities in the myocardium (e’), an estimate of pulmonary arterial pressure, and left atrial volume. There is currently no comprehensive solution to measure all these parameters solely using cardiovascular magnetic resonance (CMR). We aimed to develop and evaluate the accuracy of a comprehensive CMR DD grading approach compared to echocardiography.
Methods: Consecutive clinically referred patients (n=20, age 54±17 years, 30% female) underwent both echocardiography and CMR (MAGNETOM 1.5T Aera (n=17) or MAGNETOM 3T Skyra (n=3), Siemens Healthcare, Erlangen, Germany). Blood and myocardial velocities, respectively, were measured during breath hold using a separately validated prototype radial sector-wise golden step (SWIG) phase-contrast through-plane velocity encoded sequence (150-250 frames/second sliding window, 40 ms temporal footprint, velocity encoding 150 cm/s or 30 cm/s). Pulmonary artery pressure was estimated, as previously validated, from 4D flow analysis of pulmonary artery vortex duration using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence. Left atrial volume was measured using two and four chamber long-axis cine images and the area-length method. Routine transthoracic echocardiography was performed to measure the corresponding conventional echocardiography parameters. The data from both methods were used to perform blinded grading of DD according to the current recommendations of the American Society of Echocardiography.
Results: The grading of DD by CMR agreed with echocardiography in 17/20 (85%) of cases, where 15% were normal, 10% indeterminate, 45% grade 1 DD, 0% grad 2 DD, and 15% grade 3 DD, see Table 1.
Conclusion: A comprehensive CMR protocol for grading DD encompassing blood and myocardial velocities, estimated pulmonary artery pressure, and left atrial volume, showed very good agreement with echocardiography.