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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.

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Comparison between echocardiographic and CMR early to late peak ratios and mitral annulus peak longitudinal velocities. Panel a: comparison of the CMR velocity (EMR/AMR) and flow rate (EfMR/AfMR) ratios against the echocardiographic velocity ratio (EUS/AUS). Panel b: comparison between the mitral annulus peak longitudinal velocities estimated from echocardiographic data (E'US) and CMR data (E'MR).
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Figure 4: Comparison between echocardiographic and CMR early to late peak ratios and mitral annulus peak longitudinal velocities. Panel a: comparison of the CMR velocity (EMR/AMR) and flow rate (EfMR/AfMR) ratios against the echocardiographic velocity ratio (EUS/AUS). Panel b: comparison between the mitral annulus peak longitudinal velocities estimated from echocardiographic data (E'US) and CMR data (E'MR).

Mentions: A stronger correlation and a slope closer to 1 were found for the comparison between the echocardiographic EUS/AUS and the CMR flow rate-related EfMR/AfMR than for the comparison with the CMR velocity-related EMR/AMR (Figure 4a). In addition, although the CMR mitral annulus longitudinal velocities E'MR were lower than echocardiographic values E'US, a good correlation was found between these two velocities (Figure 4b).


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)

Comparison between echocardiographic and CMR early to late peak ratios and mitral annulus peak longitudinal velocities. Panel a: comparison of the CMR velocity (EMR/AMR) and flow rate (EfMR/AfMR) ratios against the echocardiographic velocity ratio (EUS/AUS). Panel b: comparison between the mitral annulus peak longitudinal velocities estimated from echocardiographic data (E'US) and CMR data (E'MR).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Comparison between echocardiographic and CMR early to late peak ratios and mitral annulus peak longitudinal velocities. Panel a: comparison of the CMR velocity (EMR/AMR) and flow rate (EfMR/AfMR) ratios against the echocardiographic velocity ratio (EUS/AUS). Panel b: comparison between the mitral annulus peak longitudinal velocities estimated from echocardiographic data (E'US) and CMR data (E'MR).
Mentions: A stronger correlation and a slope closer to 1 were found for the comparison between the echocardiographic EUS/AUS and the CMR flow rate-related EfMR/AfMR than for the comparison with the CMR velocity-related EMR/AMR (Figure 4a). In addition, although the CMR mitral annulus longitudinal velocities E'MR were lower than echocardiographic values E'US, a good correlation was found between these two velocities (Figure 4b).

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