Cardiac MRI to Characterize Diastolic Function
Masaki Ishida1
1Mie University Hospital, Japan

Synopsis

Keywords: Cardiovascular: Cardiac, Cardiovascular: Cardiac function, Cardiovascular: Myocardium

Diastolic dysfunction, a significant contributor to HFpEF, presents a formidable diagnostic challenge due to its diverse etiologies and complex pathophysiology. While cardiac catheterization is currently considered the reference standard for assessing LV diastolic function, it has inherent limitations, notably its invasiveness. Cardiac MRI offers a range of non-invasive, objective, and reproducible measures of diastolic function, including ventricular and atrial volumes, myocardial strain, native T1 and ECV, 4D flow, and exercise real-time cine index. These advanced CMR techniques substantially enhance noninvasive and objective evaluation of diastolic function and refine clinical management strategies for patients with diastolic dysfunction and HFpEF.

Introduction

Diastolic dysfunction, a major contributor to heart failure with preserved ejection fraction (HFpEF), poses a formidable diagnostic challenge due to its multiple etiologies and complex pathophysiology. While cardiac catheterization is currently considered the reference standard for assessing left ventricular (LV) diastolic function, its invasiveness is a notable limitation. Further, although echocardiography remains the primary imaging modality for assessing diastolic function, its limitations in accurately characterizing myocardial properties and volumes underscore the need for advanced imaging modalities. Cardiovascular magnetic resonance (CMR) has emerged as a promising tool for the comprehensive assessment of diastolic function. It offers highly reproducible assessment of LV volume and function, strain analysis, tissue characterization, 4D flow imaging, and even evaluation of exercise-induced changes in cardiac volume and function. This presentation aims to elucidate the role of cardiac MRI in characterizing diastolic function by discussing the principles of LV diastolic function assessment using invasive techniques as a reference and echocardiography as a gatekeeper, exploring various CMR techniques, their clinical applications, and future directions.

Topics

1. Overview of invasive cardiac catheterization and echocardiography for the assessment of LV diastolic function:
  • Principal and limitation
2. Comprehensive discussion on CMR evaluation of LV diastolic Function:
  • Left ventricular and atrial volumes and function.
  • LV myocardial strain.
  • Native T1 and extracellular volume (ECV).
  • 4D flow imaging.
  • Index of exercise stress real-time cine.
  • Comparison with invasive cardiac catheterization and echocardiography, highlighting the advantages of MRI.
    3. Clinical applications of CMR in LV diastolic function assessment:
  • Illustrate the clinical utility of cardiac MRI in evaluating diastolic function across various diseases, including HFpEF.
4. Future directions and challenges:
  • Emerging trends and future directions in cardiac MRI for diastolic function assessment.
  • Challenges and potential solutions in further enhancing the role of CMR in diastolic function evaluation.

Acknowledgements

None

References

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Proc. Intl. Soc. Mag. Reson. Med. 32 (2024)