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CLINICAL RESEARCH: CARDIAC MAGNETIC RESONANCE

Feasibility of tissue magnetic resonance imaging

A pilot study in comparison with tissue Doppler imaging and invasive measurement

Bernard P. Paelinck, MD^_*,_*, Albert de Roos, MD, PhD, Jeroen J. Bax, MD, PhD, Johan M. Bosmans, MD, PhD^_*, Rob J. van Der Geest, MSc, Dominique Dhondt, MSc^_*, Paul M. Parizel, MD, PhD, Christiaan J. Vrints, MD, PhD^_* and Hildo J. Lamb, MD, MSc, PhD^,_*

^_* Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
Department of Radiology, University Hospital Antwerp, Antwerp, Belgium
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands

Manuscript received July 24, 2004; revised manuscript received November 18, 2004, accepted December 13, 2004.

^_* Reprints requests: Dr. Hildo J. Lamb, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (Email: Bernard.Paelinck{at}uza.be; H.J.Lamb{at}lumc.nl).

^_* Correspondence: Dr. Bernard P. Paelinck, Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium (Email: Bernard.Paelinck{at}uza.be; H.J.Lamb{at}lumc.nl).

OBJECTIVES: This research was intended to determine the feasibility of tissue magnetic resonance (MR) imaging in comparison with tissue Doppler imaging and its potential implications for the estimation of filling pressure, in comparison with invasive measurement.

BACKGROUND: Evaluation of diastolic function using MR imaging is commonly confined to the study of transmitral flow. However, transmitral flow is unreliable for the estimation of left ventricular (LV) filling pressures in hypertrophy and normal systolic function. Normalizing early mitral velocity (E) for the influence of myocardial relaxation by combining E with early diastolic mitral septal tissue velocity (Ea) provides better Doppler estimates of filling pressures.

METHODS: Eighteen patients with hypertensive heart disease (LV mass index: 114 ± 21 g/m²), absence of valvular regurgitation, and with normal or mildly reduced systolic function (LV ejection fraction: 57.6 ± 6.5%) referred for cardiac catheterization, underwent consecutive measurement of mitral flow and septal tissue velocities with phase-contrast MR and Doppler. These data were compared with mean pulmonary capillary wedge pressure (PCWP).

RESULTS: There was a strong relation between MR (11.6 ± 4.3) and Doppler-assessed (12.1 ± 3.5) E/Ea (95% confidence interval of –1.5 to 0.5) (r = 0.89, p < 0.0001). In addition, E/Ea related strongly to invasively measured PCWP (MR: r = 0.80, p < 0.0001 and Doppler: r = 0.85, p < 0.0001).

CONCLUSIONS: Tissue MR imaging is a feasible method to assess Ea. Combining E and Ea allowed similar estimation of filling pressure by MR and Doppler, in good agreement with invasive measurement. The potential confounding effect of valvular regurgitation needs further study.

Abbreviations and Acronyms   A = peak mitral velocity at atrial contraction   CI = confidence interval   E = peak mitral velocity in early diastole   Ea = early diastolic tissue velocity   LV = left ventricle/ventricular   MR = magnetic resonance   PCWP = pulmonary capillary wedge pressure   ROI = region-of-interest

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