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

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. © 2010 bollache et al; licensee biomed central ltd.