Left ventricular (LV) diastolic function and LV filling pressure is clinically important and is routinely assessed by echocardiography. Cardiac MRI (CMR) is increasingly used in practice. We investigated the feasibility of incorporating this in routine CMR examination.
A GE HDx 3 T system with 8 channel cardiac coil was used for CMR examination. Mitral and pulmonary vein flows were obtained in 130 consecutive patients. The short axis slice with mitral valve was then used to acquire phase contrast images with VENC of 1 m/sec. Next the long axis of the LV showing the pulmonary vein, usually the right upper was acquired. An in-plane image of the pulmonary vein was obtained. Next a through plane phase contrast image of the pulmonary vein was obtained with a VENC of 80 cm/sec. Phantom images at the same mitral and pulmonary vein levels were obtained at the end of the study to correct for background noise.
Analyzable signals were obtained in all 117 patients with an average of 5 additional minutes. Mitral flow velocity signals were classified as normal, abnormal relaxation, pseudonormal and restrictive patterns using the standard criteria (figure 1). Pulmonary vein 'AR' wave duration relative to mitral 'A' wave duration was used to differentiate normal from pseudo-normal. Following patterns were noted: 19 abnormal relaxation, 1 pseudonormal, 1 restrictive, 1 atrial fibrillation with high filling pressure, 95 normal. Of the 26 with an echocardiogram within a month of CMR, 25 had fully concordant filling patterns.
1) Rapid, routine CMR assessment of LV diastolic function and LV filling pressure is feasible. 2) It correlates well with echocardiography and should be part of a complete CMR examination.