J Korean Soc Magn Reson Med.  2014 Dec;18(4):314-322. 10.13104/jksmrm.2014.18.4.314.

Diastolic Function in Patients with Hypertrophic Cardiomyopathy: Evaluation Using the Phase-contrast MRI Measurement of Mitral Valve and Pulmonary Vein Flow Velocities

• Kim EY
• Choe YH
• Kim SM
• Lee SC
• Chang SA
• Oh JK

• KMID: 2206928
• DOI: http://doi.org/10.13104/jksmrm.2014.18.4.314

Abstract

PURPOSE
Diastolic dysfunction is a common problem in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to assess the role of MRI in the assessment of diastolic function using mitral valve and pulmonary vein flow velocities in HCM patients.
METHODS AND RESULTS
Phase-contrast MRI (mitral valve and pulmonary vein) and transthoracic echocardiography was successfully performed for 59 HCM patients (44 men and 15 women; mean age, 51 years). Forty-nine patients had a diastolic dysfunction; grade 1 (n = 20), grade 2 (n = 27), and grade 3 (n = 2) using echocardiography, and ten patients had normal diastolic function. The transmitral inflow parameters (E, A, and E/A ratios) obtained by MRI showed positive correlation with the same parameters measured by echocardiography (Pearson's r values were 0.47, 0.60, and 0.75 for E, A, E/A, respectively, all P < 0.001). With the flow information of the pulmonary vein from cardiac MRI, pseudo-normalized pattern (n = 8) could be distinguished from true normal filling pattern (n = 17), and the diastolic function grades by cardiac MRI showed moderate agreement with those of echocardiography (kappa value = 0.45, P < 0.001).
CONCLUSIONS
Assessment of left ventricle diastolic function is feasible using phase-contrast MRI in HCM patients. Analysis of pulmonary vein flow velocity on MRI is useful for differentiating pseudo-normal from normal diastolic function in HCM patients.

Keyword

Cardiac magnetic resonance imaging; Blood flow velocity; Echocardiography, Doppler; Diastole

MeSH Terms

Blood Flow Velocity
Cardiomyopathy, Hypertrophic*
Diastole
Echocardiography
Echocardiography, Doppler
Female
Heart Ventricles
Humans
Magnetic Resonance Imaging*
Male
Mitral Valve*
Pulmonary Veins*

Figure

• 

  Fig. 1 Image acquisition and analysis of phase-contrast MRI at the level of the mitral valve (MV). a. Cine four-chamber image demonstrating the prescription of slice at the level of the tips of the MV leaflets. b. Phase-contrast MRI short-axis image at the level of MV leaflet tips. The contour was drawn on the leaflets as shown including the whole cross-section of the mitral inflow. c. Phase image corresponding to the magnitude images. d. Mitral flow obtained by phase-contrast MR demonstrated peaks in early diastole (E wave) and atrial systole (A wave) and deceleration time (DT). On the MRI flow curve, a vertical line was drawn from the peak of E wave to intersect the baseline, which displayed a time delay at which the E-wave peak occurred. A second line was drawn from the peak of the E wave following the downslope intersecting the baseline, which gave the time delay of the E wave. The time delay of the peak E wave was subtracted from the time delay of the E wave downslope intersecting the baseline to calculate the DT. e. Measurement of transmitral flow velocity in the transthoracic echocardiography. Ultrasound beam needs to be parallel with the direction of blood flow to obtain the optimal flow signal.

• 

  Fig. 2 Image acquisition and analysis of phase-contrast MRI at the level of the pulmonary vein. a. Cine four-chamber image demonstrating the position of a slice 1 cm inside the right superior pulmonary vein entrance into the left atrium. b, c. Phase-contrast MRI cross-section image of the right superior pulmonary vein with contours. d. Pulmonary vein flow obtained by phase-contrast MR represented antegrade peaks in systole (S) and early diastole (D) and a retrograde peak in atrial systole (Ar).

• 

  Fig. 3 Scatter plots showed positive correlation between echocardiography and MRI in the estimation of E wave (a), A wave (b), E/A ratios (c), and deceleration time (d).

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  Fig. 4 Bland-Altman plot demonstrates a mean difference between echocardiographic E/A ratio and MRI E/A ratio of -0.085 ± 0.45 (SD).

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