Limits...
Automated left ventricular diastolic function evaluation from phase-contrast cardiovascular magnetic resonance and comparison with Doppler echocardiography.

Bollache E, Redheuil A, Clément-Guinaudeau S, Defrance C, Perdrix L, Ladouceur M, Lefort M, De Cesare A, Herment A, Diebold B, Mousseaux E, Kachenoura N - J Cardiovasc Magn Reson (2010)

Bottom Line: The mean percentage of overlap between the transmitral flow segmentations performed by two independent operators was 99.7 ± 1.6%, resulting in a small variability (<1.96 ± 2.95%) in functional parameter measurement.The MR diastolic parameters varied significantly in patients as opposed to controls (p < 0.0002).A fast and reproducible technique for flow and myocardial PC-CMR data analysis was successfully used on controls and patients to extract consistent velocity-related diastolic parameters, as well as flow rate-related parameters.

View Article: PubMed Central - HTML - PubMed

Affiliation: INSERM U678/UPMC Université Paris 6, Paris, France. emilie.bollache@imed.jussieu.fr

ABSTRACT

Background: Early detection of diastolic dysfunction is crucial for patients with incipient heart failure. Although this evaluation could be performed from phase-contrast (PC) cardiovascular magnetic resonance (CMR) data, its usefulness in clinical routine is not yet established, mainly because the interpretation of such data remains mostly based on manual post-processing. Accordingly, our goal was to develop a robust process to automatically estimate velocity and flow rate-related diastolic parameters from PC-CMR data and to test the consistency of these parameters against echocardiography as well as their ability to characterize left ventricular (LV) diastolic dysfunction.

Results: We studied 35 controls and 18 patients with severe aortic valve stenosis and preserved LV ejection fraction who had PC-CMR and Doppler echocardiography exams on the same day. PC-CMR mitral flow and myocardial velocity data were analyzed using custom software for semi-automated extraction of diastolic parameters. Inter-operator reproducibility of flow pattern segmentation and functional parameters was assessed on a sub-group of 30 subjects. The mean percentage of overlap between the transmitral flow segmentations performed by two independent operators was 99.7 ± 1.6%, resulting in a small variability (<1.96 ± 2.95%) in functional parameter measurement. For maximal myocardial longitudinal velocities, the inter-operator variability was 4.25 ± 5.89%. The MR diastolic parameters varied significantly in patients as opposed to controls (p < 0.0002). Both velocity and flow rate diastolic parameters were consistent with echocardiographic values (r > 0.71) and receiver operating characteristic (ROC) analysis revealed their ability to separate patients from controls, with sensitivity > 0.80, specificity > 0.80 and accuracy > 0.85. Slight superiority in terms of correlation with echocardiography (r = 0.81) and accuracy to detect LV abnormalities (sensitivity > 0.83, specificity > 0.91 and accuracy > 0.89) was found for the PC-CMR flow-rate related parameters.

Conclusions: A fast and reproducible technique for flow and myocardial PC-CMR data analysis was successfully used on controls and patients to extract consistent velocity-related diastolic parameters, as well as flow rate-related parameters. This technique provides a valuable addition to established CMR tools in the evaluation and the management of patients with diastolic dysfunction.

Show MeSH

Related in: MedlinePlus

Colour-coded display of the blood flow and myocardial longitudinal velocity-encoded PC images. Panel a: blood flow velocity images, selected during a systolic phase (left), in which we can visualize the aortic ejection flow, and a diastolic phase (right), in which we can visualize the transmitral filling flow. Panel b: myocardial longitudinal velocity images, selected at the beginning of the systolic phase (left) and at the beginning of the diastolic phase (right). Negative velocity values were colour-coded in hot tones while positive velocity values were colour-coded in cold tones, to distinguish between through plane velocities in both directions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2991299&req=5

Figure 1: Colour-coded display of the blood flow and myocardial longitudinal velocity-encoded PC images. Panel a: blood flow velocity images, selected during a systolic phase (left), in which we can visualize the aortic ejection flow, and a diastolic phase (right), in which we can visualize the transmitral filling flow. Panel b: myocardial longitudinal velocity images, selected at the beginning of the systolic phase (left) and at the beginning of the diastolic phase (right). Negative velocity values were colour-coded in hot tones while positive velocity values were colour-coded in cold tones, to distinguish between through plane velocities in both directions.

Mentions: Blood flow and myocardial velocity PC images were transferred for off-line analysis using a custom software. This software allowed a display of velocity images using an adapted colour scale designed to distinguish through-plane velocities in both directions (Figure 1). Our software included algorithms for blood flow and tissue delineation, as well as velocity and flow rate curves analysis.


Automated left ventricular diastolic function evaluation from phase-contrast cardiovascular magnetic resonance and comparison with Doppler echocardiography.

Bollache E, Redheuil A, Clément-Guinaudeau S, Defrance C, Perdrix L, Ladouceur M, Lefort M, De Cesare A, Herment A, Diebold B, Mousseaux E, Kachenoura N - J Cardiovasc Magn Reson (2010)

Colour-coded display of the blood flow and myocardial longitudinal velocity-encoded PC images. Panel a: blood flow velocity images, selected during a systolic phase (left), in which we can visualize the aortic ejection flow, and a diastolic phase (right), in which we can visualize the transmitral filling flow. Panel b: myocardial longitudinal velocity images, selected at the beginning of the systolic phase (left) and at the beginning of the diastolic phase (right). Negative velocity values were colour-coded in hot tones while positive velocity values were colour-coded in cold tones, to distinguish between through plane velocities in both directions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2991299&req=5

Figure 1: Colour-coded display of the blood flow and myocardial longitudinal velocity-encoded PC images. Panel a: blood flow velocity images, selected during a systolic phase (left), in which we can visualize the aortic ejection flow, and a diastolic phase (right), in which we can visualize the transmitral filling flow. Panel b: myocardial longitudinal velocity images, selected at the beginning of the systolic phase (left) and at the beginning of the diastolic phase (right). Negative velocity values were colour-coded in hot tones while positive velocity values were colour-coded in cold tones, to distinguish between through plane velocities in both directions.
Mentions: Blood flow and myocardial velocity PC images were transferred for off-line analysis using a custom software. This software allowed a display of velocity images using an adapted colour scale designed to distinguish through-plane velocities in both directions (Figure 1). Our software included algorithms for blood flow and tissue delineation, as well as velocity and flow rate curves analysis.

Bottom Line: The mean percentage of overlap between the transmitral flow segmentations performed by two independent operators was 99.7 ± 1.6%, resulting in a small variability (<1.96 ± 2.95%) in functional parameter measurement.The MR diastolic parameters varied significantly in patients as opposed to controls (p < 0.0002).A fast and reproducible technique for flow and myocardial PC-CMR data analysis was successfully used on controls and patients to extract consistent velocity-related diastolic parameters, as well as flow rate-related parameters.

View Article: PubMed Central - HTML - PubMed

Affiliation: INSERM U678/UPMC Université Paris 6, Paris, France. emilie.bollache@imed.jussieu.fr

ABSTRACT

Background: Early detection of diastolic dysfunction is crucial for patients with incipient heart failure. Although this evaluation could be performed from phase-contrast (PC) cardiovascular magnetic resonance (CMR) data, its usefulness in clinical routine is not yet established, mainly because the interpretation of such data remains mostly based on manual post-processing. Accordingly, our goal was to develop a robust process to automatically estimate velocity and flow rate-related diastolic parameters from PC-CMR data and to test the consistency of these parameters against echocardiography as well as their ability to characterize left ventricular (LV) diastolic dysfunction.

Results: We studied 35 controls and 18 patients with severe aortic valve stenosis and preserved LV ejection fraction who had PC-CMR and Doppler echocardiography exams on the same day. PC-CMR mitral flow and myocardial velocity data were analyzed using custom software for semi-automated extraction of diastolic parameters. Inter-operator reproducibility of flow pattern segmentation and functional parameters was assessed on a sub-group of 30 subjects. The mean percentage of overlap between the transmitral flow segmentations performed by two independent operators was 99.7 ± 1.6%, resulting in a small variability (<1.96 ± 2.95%) in functional parameter measurement. For maximal myocardial longitudinal velocities, the inter-operator variability was 4.25 ± 5.89%. The MR diastolic parameters varied significantly in patients as opposed to controls (p < 0.0002). Both velocity and flow rate diastolic parameters were consistent with echocardiographic values (r > 0.71) and receiver operating characteristic (ROC) analysis revealed their ability to separate patients from controls, with sensitivity > 0.80, specificity > 0.80 and accuracy > 0.85. Slight superiority in terms of correlation with echocardiography (r = 0.81) and accuracy to detect LV abnormalities (sensitivity > 0.83, specificity > 0.91 and accuracy > 0.89) was found for the PC-CMR flow-rate related parameters.

Conclusions: A fast and reproducible technique for flow and myocardial PC-CMR data analysis was successfully used on controls and patients to extract consistent velocity-related diastolic parameters, as well as flow rate-related parameters. This technique provides a valuable addition to established CMR tools in the evaluation and the management of patients with diastolic dysfunction.

Show MeSH
Related in: MedlinePlus