Integrated assessment of diastolic and systolic ventricular function using diagnostic cardiac magnetic resonance catheterization: validation in pigs and application in a clinical pilot study.
OBJECTIVE
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.
Schmitt
Boris
B
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. schmitt@dhzb.de
Steendijk
Paul
P
Lunze
Karsten
K
Ovroutski
Stanislav
S
Falkenberg
Jan
J
Rahmanzadeh
Pedram
P
Maarouf
Nizar
N
Ewert
Peter
P
Berger
Felix
F
Kuehne
Titus
T
D000818:Animals; D006328:Cardiac Catheterization; D003971:Diastole; D004280:Dobutamine; D018729:Fontan Procedure; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D009200:Myocardial Contraction; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013552:Swine; D013599:Systole; D013997:Time Factors; D018754:Ventricular Dysfunction / Q000175:diagnosis* / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure
D004280:Dobutamine