Impact of diastolic dysfunction severity on global left ventricular volumetric filling - assessment by automated segmentation of routine cine cardiovascular magnetic resonance.
Impact of diastolic dysfunction severity on global left ventricular volumetric filling - assessment by automated segmentation of routine cine cardiovascular magnetic resonance.
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DOI：
10.1186/1532-429x-12-46
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发表时间：
2010-07-31
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影响因子：
--
通讯作者：
Weinsaft JW
中科院分区：
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作者：
Mendoza DD;Codella NC;Wang Y;Prince MR;Sethi S;Manoushagian SJ;Kawaji K;Min JK;LaBounty TM;Devereux RB;Weinsaft JW
通过常规电影心血管磁共振（CMR）的自动处理，检查超声心动图（回声）证实的舒张功能障碍（DD）严重程度与容积充盈之间的关系。Cine-CMR提供左心室（LV）腔室容积的高分辨率评估。自动分割（LV-METRIC）通过分割所有时间相位的所有短轴图像生成LV充盈曲线。本研究使用电影CMR评估进行性DD发生的充盈变化。115例MI后患者在1天内接受了CMR和超声心动图检查。LV-METRIC产生了多个舒张指数- E：A比、峰值充盈率（PFR）、峰值充盈率时间（TPFR）和舒张期容积恢复（DVR 80-恢复80%每搏输出量所需的阿摩尔比例）。Echo是DD的参考。LV-METRIC在所有患者中成功生成LV充盈曲线。CMR指数具有重现性（阅片者间差异≤ 1%），所需处理时间最短（175 ± 34张图像/检查，2：09 ± 0：51分钟）。CMR E：A比率随1级DD降低，随2-3级DD升高。DVR 80或TPFR测量的舒张期充盈间期，1级DD延长，3级DD缩短，与回声减速时间平行（p < 0.001）。CMR的PFR随DD分级增加而增加，与E/e'相似（p < 0.001）。长时间DVR 80识别出71%的患者为超声心动图证实的1级DD，但无患者为3级DD，每搏输出量调整的PFR识别出67%的患者为3级DD，但无患者为1级DD（匹配特异性= 83%）。DVR 80和PFR的组合确定了53%的2级DD患者。DVR 80延长与1级（OR 2.79，CI 1.65-4.05，p = 0.001）相关，与2级（OR 1.35，CI 0.98-1.74，p = 0.06）的趋势相似，而PFR高与3级（OR 1.14，CI 1.02-1.25，p = 0.02）DD相关。自动电影-CMR分割可以识别随着回声证实的DD严重程度增加而发生的LV充盈变化。松弛受损与充盈间隔延长有关，而限制性充盈的特征在于充盈速率增加。
To examine relationships between severity of echocardiography (echo) -evidenced diastolic dysfunction (DD) and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR). Cine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Automated segmentation (LV-METRIC) yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD. 115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR), time to peak filling rate (TPFR), and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume). Echo was the reference for DD. LV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (≤ 1% inter-reader differences) and required minimal processing time (175 ± 34 images/exam, 2:09 ± 0:51 minutes). CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p < 0.001). PFR by CMR increased with DD grade, similar to E/e' (p < 0.001). Prolonged DVR80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%). The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001) with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06), whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02) DD. Automated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged filling intervals whereas restrictive filling is characterized by increased filling rates.