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Integrated Assessment of Diastolic and Systolic Ventricular Function Using Diagnostic Cardiac Magnetic Resonance Catheterization

Validation in Pigs and Application in a Clinical Pilot Study

Boris Schmitt, MD^_*,_*, Paul Steendijk, PhD, Karsten Lunze, MD^_*, Stanislav Ovroutski, MD^_*, Jan Falkenberg, MD^_*, Pedram Rahmanzadeh, MD^_*, Nizar Maarouf, MD^_*, Peter Ewert, MD, PhD^_*, Felix Berger, MD, PhD^_*, Titus Kuehne, MD, PhD^_*

^_* Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Departments of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands

^_* Reprint requests and correspondence: Dr. Boris Schmitt, German Heart Institute Berlin, Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, Berlin 13353, Germany (Email: schmitt{at}dhzb.de).

Objectives: This study sought to develop and validate a method for the integrated analysis of systolic and diastolic ventricular function.

Background: An integrated approach to assess ventricular pump function, myocontractility (end-systolic pressure–volume relationship [ESPVR]), and diastolic compliance (end-diastolic pressure–volume relation [EDPVR]) is of high clinical value. Cardiac magnetic resonance (CMR) is well established for measuring global pump function, and catheterization-combined CMR was previously shown to accurately measure ESPVR, but not yet the EDPVR.

Methods: In 8 pigs, the CMR technique was compared with conductance catheter methods (gold standard) for measuring the EDPVR in the left and right ventricle. Measurements were performed at rest and during dobutamine administration. For CMR, the ESPVR was estimated with a single-beat approach by synchronizing invasive ventricular pressures with cine CMR–derived ventricular volumes. The EDPVR was determined during pre-load reduction from additional volume data that were obtained from real-time velocity-encoded CMR pulmonary/aortic blood flow measurements. Pre-load reduction was achieved by transient balloon occlusion of the inferior vena cava. The stiffness coefficient β was calculated by an exponential fit from the EDPVR. After validation in the animal experiments, the EDPVR was assessed in a pilot study of 3 patients with a single ventricle using identical CMR and conductance catheter techniques.

Results: Bland-Altman tests showed good agreement between conductance catheter–derived and CMR-derived EDPVR. In both ventricles of the pigs, dobutamine enhanced myocontractility (p < 0.01), increased stroke volume (p < 0.01), and improved diastolic function. The latter was evidenced by shorter early relaxation (p < 0.05), a downward shift of the EDPVR, and a decreased stiffness coefficient β (p < 0.05). In contrast, in the patients, early relaxation was inconspicuous but the EDPVR shifted left-upward and the stiffness constant remained unchanged. The observed changes in diastolic function were not significantly different when measured with conductance catheter and CMR.

Conclusions: This novel CMR method provides differential information about diastolic function in conjunction with parameters of systolic contractility and global pump function.

Key Words: cardiac magnetic resonance • diagnostic catheterization • pressure–volume loops • diastolic function

Abbreviations and Acronyms   β = stiffness constant   CMR = cardiac magnetic resonance   EDPVR = end-diastolic pressure–volume relation   Emax = slope of the end-systolic pressure–volume relation   Emax,i = slope of the end-systolic pressure–volume relation indexed to 100 mg myocardial muscle mass   ESPVR = end systolic pressure–volume relation    = parameter of early diastolic relaxation   VEC = velocity-encoded cine

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