Thomas Kennedy1, Niti Aggarwal2, Christopher Francois1, Mark Schiebler1, and Jeremy Collins3
1Radiology, University of Wisconsin- Madison, Madison, WI, United States, 2Cardiology, Univesity of Wisconsin-Madison, Madison, WI, United States, 3Radiology, Northwestern University, Chicago, IL, United States
Synopsis
Diastolic dysfunction is the primary cause of CHF in 40-60%
of patients with heart failure in the United States and has been shown to lead
to poor outcomes. Early diagnosis and
treatment of the causes of diastolic dysfunction is effective in relieving symptoms and
reducing mortality. The non- invasive methods which can be used to assess
diastolic function include cardiac magnetic resonance (CMR) imaging. The
purpose of this educational poster is to describe the CMR techniques which can
be used to evaluate diastolic function and review the CMR findings of this
disorder.Purpose
Diastolic dysfunction is the primary cause of CHF in 40-60%
of patients with heart failure in the United States (1). Furthermore, diastolic
dysfunction, in the setting of normal ejection fraction, has been shown to lead
to poor outcomes (2). Early diagnosis
and treatment of diastolic dysfunction is important in ameliorating symptoms
and reducing mortality (3). There are invasive and noninvasive methods which
can be used to assess diastolic function including invasive cardiac angiography
(ICA), echocardiography and cardiac magnetic resonance (CMR) imaging. The
purpose of this educational poster is to (A) review the pathophysiology of
diastolic dysfunction, (B) discuss CMR techniques which can be used to evaluate
diastolic function and (C) review the CMR findings of diastolic dysfunction.
Outline of Content
1.
Background
a.
Definition of diastolic dysfunction
b. Review of
the pathophysiology of diastolic dysfunction and the non CMR diagnostic methods
c. Common
causes (HTN, Amyloid, Atrial fibrillation, Diabetes, Sarcoidosis)
d. Survival
without and with therapy
e.Current methods for diagnosis using
catheterization and echocardiography.
2. CMR techniques used to evaluate diastolic
function
a. Phase contrast (PC) MRI
i. Basic PC physics
ii. Applications for diastolic function
1.Transmitral velocity
a.
E, A, E/A ratio, deceleration time of E wave
2. Tissue phase mapping
a.
Regional myocardial velocities
b.
E’, A’, E/E’
3. Pulmonary Vein Velocity
b. Cine balanced steady state free precession (bSSFP)
i. Cine bSSFP physics
ii. Applications for diastolic function
1.
Ventricular volume analysis
a. Peak filling rate
b. Time to peak filling rate
2. Myocardial strain analysis
a.
Feature Tracking
b. Heart Deformation Analysis
3. Techniques to assess left atrial size
c.
Myocardial Tagging
i. Tagging physics
ii. Applications for diastolic function
1. Assess deformation of myocardium
a.
Strain, strain rate, twisting/untwisting
d. Additional tissue characterization sequences
i. T1/T2 mapping, late gadolinium enhancement
1.
Identify specific etiologies of diastolic
dysfunction
e. Pitfalls/limitations of MR techniques for
assessment of diastolic dysfunction
3. CMR findings in diastolic dysfunction: Case
examples of normal and abnormal diastolic function with CMR
Summary
CMR is an effective noninvasive method for evaluating
diastolic function, with good correlation between echocardiography and CMR
in evaluating diastolic function (1,2). After reviewing this educational exhibit, the
cardiac imager should become more cognizant of the CMR techniques used to
assess diastolic function and recognize the CMR findings in diastolic
dysfunction.
Acknowledgements
No acknowledgement found.References
1. Rathi V, et al. Journal of Cardiolvasc Magn Reson 2008,
10:36.
2. Bollche E, et al. Journal of Cardiovasc Magn Reson 2010,
12:63.
3. Angeja B, Grossman W. Circulation 2003, 107:659-663.