Evaluation of left ventricular and left atrial volumetric function from native MR multislice 4D flow magnitude data

Reiter, Clemens; Reiter, Gert; Kräuter, Corina; Scherr, Daniel; Schmidt, Albrecht; Fuchsjäger, Michael; Reiter, Ursula

doi:10.1007/s00330-023-10017-3

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“…The study did not aim to optimize time of 4D flow acquisition or the analysis time. The multislice 4D flow protocol was chosen to optimize the “anatomical” contrast in native 4D flow acquisitions [ 41 ]. Apart from the aforementioned reduction of the stack volume, acquisition time could be further reduced by using effective navigator gating and/or compressed sensing techniques [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

MR 4D flow–derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction

Reiter,

Kräuter

et al. 2023

Eur Radiol

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Objectives The magnetic resonance (MR) 4D flow imaging–derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. Methods Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. Results Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958–1.000), yielding sensitivity of 100% (95% CI: 84–100%) and specificity of 99% (95% CI: 93–100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976–1.000) at cut-off α ≥ 2.14. Conclusion The 4D flow–derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. Clinical relevance statement As a single continuous parameter, the 4D flow–derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. Key Points • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow–derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.

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Section: Discussionmentioning

confidence: 99%