Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
Siemens Healthcare Diagnostics, Graz, Austria.
JACC Cardiovasc Imaging. 2020 Dec;13(12):2530-2542. doi: 10.1016/j.jcmg.2020.06.027. Epub 2020 Aug 19.
The aims of this study were to develop a comprehensive cardiovascular magnetic resonance (CMR) approach to diastolic dysfunction (DD) grading and to evaluate the accuracy of CMR in the diagnosis of DD compared with echocardiography.
Left ventricular DD is routinely assessed using echocardiography.
Consecutive clinically referred patients (n = 46; median age 59 years; interquartile range: 46 to 68 years; 33% women) underwent both conventional echocardiography and CMR. CMR diastolic transmitral velocities (E and A) and myocardial tissue velocity (e') were measured during breath-hold using a validated high-temporal resolution radial sector-wise golden-angle velocity-encoded sequence. CMR pulmonary artery pressure was estimated from 4-dimensional flow analysis of blood flow vortex duration in the pulmonary artery. CMR left atrial volume was measured using the biplane long-axis area-length method. Both CMR and echocardiographic data were used to perform blinded grading of DD according to the 2016 joint American and European recommendations.
Grading of DD by CMR agreed with that by echocardiography in 43 of 46 cases (93%), of which 9% were normal, 2% indeterminate, 63% grade 1 DD, 4% grade 2 DD, and 15% grade 3 DD. There was a very good categorical agreement, with a weighted Cohen kappa coefficient of 0.857 (95% confidence interval: 0.73 to 1.00; p < 0.001).
A comprehensive CMR protocol for grading DD encompassing diastolic blood and myocardial velocities, estimated pulmonary artery pressure, and left atrial volume showed very good agreement with echocardiography.
本研究旨在建立一种全面的心血管磁共振（CMR）评估舒张功能障碍（DD）的方法，并评估 CMR 诊断 DD 的准确性与超声心动图相比。
左心室 DD 通常通过超声心动图进行评估。
连续入组的临床转诊患者（n=46；中位年龄 59 岁；四分位间距：46 至 68 岁；33%为女性）同时接受常规超声心动图和 CMR 检查。使用验证的高时间分辨率径向扇区黄金角度速度编码序列在屏气期间测量 CMR 舒张期经二尖瓣速度（E 和 A）和心肌组织速度（e'）。通过肺动脉血流涡旋持续时间的 4 维血流分析来估计 CMR 肺动脉压。使用双平面长轴面积长度法测量 CMR 左心房容积。根据 2016 年美国和欧洲联合建议，使用 CMR 和超声心动图数据对 DD 进行盲法分级。
46 例患者中有 43 例（93%）的 CMR 分级与超声心动图一致，其中 9%为正常，2%为不确定，63%为 1 级 DD，4%为 2 级 DD，15%为 3 级 DD。分类一致性非常好，加权 Cohen kappa 系数为 0.857（95%置信区间：0.73 至 1.00；p<0.001）。
一个全面的 CMR 方案，包括舒张期血液和心肌速度、估计肺动脉压和左心房容积，与超声心动图具有非常好的一致性。
