Department of Medicine, Weill Cornell Medical College, NY, NY, USA.
J Cardiovasc Magn Reson. 2010 Jul 31;12(1):46. doi: 10.1186/1532-429X-12-46.
To examine relationships between severity of echocardiography (echo) -evidenced diastolic dysfunction (DD) and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR).
Cine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Automated segmentation (LV-METRIC) yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD.
115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR), time to peak filling rate (TPFR), and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume). Echo was the reference for DD.
LV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (< or = 1% inter-reader differences) and required minimal processing time (175 +/- 34 images/exam, 2:09 +/- 0:51 minutes). CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p < 0.001). PFR by CMR increased with DD grade, similar to E/e' (p < 0.001). Prolonged DVR80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%). The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001) with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06), whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02) DD.
Automated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged filling intervals whereas restrictive filling is characterized by increased filling rates.
通过自动处理常规心血管磁共振（CMR）电影，研究超声心动图（echo）证据表明的舒张功能障碍（DD）严重程度与容积充盈之间的关系。
电影 CMR 可提供左心室（LV）腔容积的高分辨率评估。自动分割（LV-METRIC）通过对所有时间相位的所有短轴图像进行分割，生成 LV 充盈曲线。本研究使用电影 CMR 评估随着逐渐加重的 DD 而发生的充盈变化。
115 例心梗后患者在 1 天内接受 CMR 和 echo 检查。LV-METRIC 生成多个舒张指数 - E:A 比值、峰值充盈率（PFR）、充盈率达峰时间（TPFR）和舒张期容积恢复（DVR80 - 恢复 80%心排量所需的舒张期比例）。Echo 是 DD 的参考。
LV-METRIC 成功地为所有患者生成了 LV 充盈曲线。CMR 指数具有可重复性（<或= 1%的读者间差异），且处理时间最短（每个检查 175 +/- 34 个图像，2:09 +/- 0:51 分钟）。CMR 的 E:A 比值随 1 级和 2-3 级 DD 而降低。用 DVR80 或 TPFR 测量的舒张期充盈间隔随 1 级 DD 而延长，随 3 级 DD 而缩短，与回声减速时间平行（p < 0.001）。PFR 随 DD 等级而增加，与 E/e'相似（p < 0.001）。DVR80 延长可识别 71%的 1 级 echo 证据但无 3 级 DD 的患者，校正 stroke-volume 的 PFR 可识别 67%的 3 级但无 1 级 DD 的患者（匹配特异性= 83%）。DVR80 和 PFR 的联合可识别 53%的 2 级 DD 患者。DVR80 延长与 1 级相关（OR 2.79，CI 1.65-4.05，p = 0.001），与 2 级也有相似趋势（OR 1.35，CI 0.98-1.74，p = 0.06），而高 PFR 与 3 级相关（OR 1.14，CI 1.02-1.25，p = 0.02）DD。
自动电影 CMR 分割可辨别与 echo 证据表明的 DD 严重程度增加相关的 LV 充盈变化。松弛不良与充盈间隔延长有关，而限制充盈则表现为充盈率增加。
