Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Eur Radiol. 2024 Jun;34(6):4065-4076. doi: 10.1007/s00330-023-10386-9. Epub 2023 Nov 13.
The magnetic resonance (MR) 4D flow imaging-derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method.
Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (v), systolic peak inflow velocity (v), and early diastolic peak inflow velocity (v) were evaluated from 4D flow data. α was calculated from α = v / [(v + v) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis.
Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958-1.000), yielding sensitivity of 100% (95% CI: 84-100%) and specificity of 99% (95% CI: 93-100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976-1.000) at cut-off α ≥ 2.14.
The 4D flow-derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other.
As a single continuous parameter, the 4D flow-derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events.
• Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow-derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.
最近提出了磁共振（MR）4D 流成像衍生的左心房（LA）加速度因子α，作为一种无创估计 LA 压力的方法。我们旨在使用超声心动图作为参考方法，研究α与左心室（LV）舒张功能障碍严重程度的相关性。
前瞻性地对 94 例受试者（44 例男性/50 例女性；平均年龄 62±12 岁）进行 LV 舒张功能的超声心动图评估和 3-T 心脏 MR 4D 流成像。从 4D 流数据评估 LA 早期舒张峰流出速度（v）、收缩期峰值流入速度（v）和早期舒张期峰值流入速度（v）。α 通过α=v/[(v+v)/2]计算得出。通过 t 检验比较平均参数值；通过接收者操作特征曲线分析研究α在预测舒张（dys）功能方面的诊断性能。
α 值分别为 1.17±0.14、1.20±0.08、1.33±0.15、1.77±0.18 和 2.79±0.69，用于分级 0（n=51）、不确定（n=9）、分级 I（n=13）、分级 II（n=13）和分级 III（n=8）LV 舒张（dys）功能。有非晚期（分级<II）和晚期（分级≥II）舒张功能障碍的受试者之间的α值存在差异（1.20±0.15 与 2.16±0.66，p<0.001）。检测晚期舒张功能障碍的曲线下面积（AUC）为 0.998（95%CI：0.958-1.000），得出 100%（95%CI：84-100%）的灵敏度和 99%（95%CI：93-100%）的特异性，α≥1.58 时的特异性。α≥2.14 时，分级 III 舒张功能障碍的 AUC 也为 0.998（95%CI：0.976-1.000）。
4D 流衍生的 LA 加速度因子α可区分 II 级和 III 级舒张功能障碍与非晚期分级以及彼此之间的差异。
作为一个单一的连续参数，4D 流衍生的 LA 加速度因子α具有简化用于诊断晚期 LV 舒张功能障碍的多参数成像算法的潜力，从而确定心血管事件风险增加的患者。
• 通常采用复杂的多参数方法来检测晚期舒张功能障碍。
• 4D 流衍生的左心房加速度因子α单独使用即可准确检测晚期左心室舒张功能障碍。
• 作为一个单一的连续参数，左心房加速度因子α可以简化晚期舒张功能障碍的诊断。
