Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
Eur Radiol. 2022 Dec;32(12):8131-8139. doi: 10.1007/s00330-022-08938-6. Epub 2022 Jul 2.
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).
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).
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).
PTTc may represent a non-invasive quantitative surrogate marker for the detection and assessment of diastolic dysfunction in LHD patients.
• 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.
左心室（LV）舒张功能的无创评估仍然具有挑战性。已有报道称，首过灌注心脏磁共振（CMR）参数在定量血液动力学分析中的作用。因此，我们旨在验证这些参数对左心疾病（LHD）患者 LV 舒张功能障碍的诊断能力和准确性，并与心导管术进行比较。
我们回顾性纳入了 77 例接受 CMR 成像和心导管术的 LHD 患者。LV 舒张功能障碍定义为心导管术时肺毛细血管楔压（PCWP）或 LV 舒张末期压（LVEDP）>12mmHg。在首过灌注 CMR 成像中，肺动脉通过时间（PTT）被定义为血液从左心室通过肺血管系统流向右心室（RV）的时间。肺动脉通过搏动（PTB）是在该时间段内的心脏搏动次数，而体表面积校正的肺血容量（PBVi）是 PTB 和 RV 每搏输出量指数（RVSVi）的乘积。
77 例 LHD 患者中，53 例（68.83%）被发现存在 LV 舒张功能障碍，与无 LV 舒张功能障碍的患者相比，PTTc、PTB 和 PBVi 显著升高（p<0.05）。多变量分析显示，仅 PTTc 和 PTB 是 LV 舒张功能障碍的独立预测因子（p<0.05）。当 PTTc 的最佳截断值为 11.9s 时，对 LV 舒张功能障碍的诊断性能最佳（曲线下面积=0.83，p<0.001）。
PTTc 可能是一种用于检测和评估 LHD 患者舒张功能障碍的无创定量替代指标。
PTTc 对舒张功能障碍的诊断准确性最佳，最佳截断值为 11.9s，特异性为 100%。
PTTc 和 PTB 是不同多变量模型中 LV 舒张功能障碍的独立预测因子，具有较高的可重复性。
PTTc 是一种有前途的无创替代标志物，可用于检测和评估 LHD 患者的舒张功能障碍。
