Document Detail

Integrated assessment of diastolic and systolic ventricular function using diagnostic cardiac magnetic resonance catheterization: validation in pigs and application in a clinical pilot study.
MedLine Citation:
PMID:  19909930     Owner:  NLM     Status:  MEDLINE    
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 beta 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 beta (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.
Boris Schmitt; Paul Steendijk; Karsten Lunze; Stanislav Ovroutski; Jan Falkenberg; Pedram Rahmanzadeh; Nizar Maarouf; Peter Ewert; Felix Berger; Titus Kuehne
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-13     Completed Date:  2010-01-26     Revised Date:  2010-03-19    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1271-81     Citation Subset:  IM    
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
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MeSH Terms
Dobutamine / diagnostic use
Fontan Procedure
Heart Catheterization*
Magnetic Resonance Imaging, Cine*
Myocardial Contraction*
Pilot Projects
Predictive Value of Tests
Reproducibility of Results
Time Factors
Ventricular Dysfunction / diagnosis*,  physiopathology
Ventricular Function, Left*
Ventricular Function, Right*
Ventricular Pressure
Reg. No./Substance:
Comment In:
JACC Cardiovasc Imaging. 2009 Nov;2(11):1282-4   [PMID:  19909931 ]
JACC Cardiovasc Imaging. 2010 Mar;3(3):328; author reply 328-9   [PMID:  20223433 ]

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