Longitudinal Shortening of the Left Ventricle by Cine-CMR for Assessment of Diastolic Function in Patients with Aortic Valve Disease

Ribeiro, Sergio Marrone; Azevedo Filho, Clerio Francisco de; Sampaio, Roney; Tarasoutchi, Flávio; Grinberg, Max; Kalil-Filho, Roberto; Rochitte, Carlos Eduardo

doi:10.5935/abc.20190193

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Original Article • Arq. Bras. Cardiol. 114 (2) • Feb 2020 • https://doi.org/10.5935/abc.20190193 copy

Longitudinal Shortening of the Left Ventricle by Cine-CMR for Assessment of Diastolic Function in Patients with Aortic Valve Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Diastolic dysfunction, commonly evaluated by echocardiography, is an important early finding in many cardiomyopathies. Cardiac magnetic resonance (CMR) often requires specialized sequences that extends the test time. Recently, feature-tracking imaging has been made available, but still requires expensive software and lacks clinical validation.

Objective:

To assess diastolic function in patients with aortic valve disease (AVD) and compare it with normal controls by evaluating left ventricular (LV) longitudinal displacement by CMR.

Methods:

We compared 26 AVD patients with 19 normal controls. Diastolic function was evaluated as LV longitudinal displacement in 4-chamber view cine-CMR images using steady state free precession (SSFP) sequence during the entire cardiac cycle with temporal resolution < 50 ms. The resulting plot of atrioventricular junction (AVJ) position versus time generated variables of AVJ motion. Significance level of p < 0.05 was used.

Results:

Maximum longitudinal displacement (0.12 vs. 0.17 cm), maximum velocity during early diastole (MVED, 0.6 vs. 1.4s^-1), slope of the best-fit line of displacement in diastasis (VDS, 0.22 vs. 0.03s^-1), and VDS/MVED ratio (0.35 vs. 0.02) were significantly reduced in AVD patients compared with controls, respectively. Aortic regurgitation showed significantly worse longitudinal LV shortening compared with aortic stenosis. Higher LV mass indicated worse diastolic dysfunction.

Conclusions:

A simple linear measurement detected significant differences on LV diastolic function between AVD patients and controls. LV mass was the only independent predictor of diastolic dysfunction in these patients. This method can help in the evaluation of diastolic dysfunction, improving cardiomyopathy detection by CMR, without prolonging exam time or depending on expensive software.

Keywords:
Cardiovascular Diseases/mortality; Cardiomyopathy, Hypertrophic/complications; Diagnostic Imaging; Echocardiography; Magnetic Resonance Spectroscopy; Heart Failure; Aortic Valve Insufficiency

	Aortic regurgitation	Aortic stenosis	Controls	p
n (%)	11(42.3)	15 (57.7)	19
Age, years	46.0 ± 15.7	48.7 ± 11.3	38.1 ± 10.5	0.610/0.039^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
Men, n (%)	10(90.9)	9(60.0)	10(52.6)	0.079/0.101^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
Weight (kg)	76.6 ± 10.6	71.2 ± 11.9	67.9 ± 15.3	0.336/0.356^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
BMI (kg/m²)	27.9 ± 3.5	26.3 ± 3.8	23.5 ± 3.6	0.382/0.021^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
Etiology
Rheumatic	9(81.8)	3(20.0)	-
Bicuspid	2(18.2)	8(53.3)	-
Degenerative/Calcification	0 (0.0)	4(26.7)	-	0.007
NYHA Functional class
I	1(9.1)	0(0.0)	19(100.0)
II	7(63.6)	8(53.3)	0(0.0)
III	3(27.3)	7(46.7)	0(0.0)	0.526
Heart rate, bpm	65.0 ± 11.9	81.5 ± 20.7	70.1 ± 10.6	0.027/0.019^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
SBP	126.7 ± 15.1	121.5 ± 15.2	111.6 ± 8.98	0.505/0.018^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
DBP	80 ± 8.9	71.8 ± 12.8	71.3 ± 6.6	0.183 / 0.143^* * comparison the three groups including controls; remaining p values for comparison between aortic regurgitation and stenosis only.
Angina	0(0.0)	1(6.7)	-	0.465
Syncope	0(0.0)	1(6.7)	-	0.465
Hypertension	6(54.6)	6(40.0)	-	0.100
Diabetes	0(0.0)	1(13.3)	-	0.342
Hypercholesterolemia	0(0.0)	0(0.0)	-	-
Smoking	0(0.0)	5(33.3)	-	0.100
Family History of CAD	4(36.4)	3(20.0)	-	0.190

	Aortic regurgitation	Aortic stenosis	Controls	p
n (%)	11(42.3)	15 (57.7)	19
LVEDV, ml	299.6 ± 68.5	179.99 ± 42.1	129 ± 24.7	< 0.001
LVESV, ml	148.9 ± 60.4	82.0 ± 28.7	45.5 ± 9.4	< 0.001
LVEF, %	51.7 ± 11.4	55.1 ± 9.1	64.7 ± 5.3	< 0.001
LV mass, g	264.2 ± 42.4	272.8 ± 45.5	118.1 ± 40.5	< 0.001
Eccentric Hypertrophy, n (%)	10(90.9)	1(6.7)	-
Concentric Hypertrophy, n (%)	1(9.1)	14(93.3)	-	< 0.001

	Control	AVD	p
MD (cm)	-0.169 ± 0.034	-0.115 ± 0.035	< 0.0001
MVED (s^-1)	1.439 ± 0.388	0.65 ± 0.413	< 0.0001
VDS (s^-1)	0.029 ± 0.069	0.224 ± 0.232	< 0.0001
VDS/MVED	0.021 ± 0.051	0.352 ± 0.292	< 0.0001

	Stenosis	Regurgitation	p
MD (cm)	-0.130 ± 0.036	-0.093 ± 0.018	0.0026
MVED(s^-1)	0,790 ± 0.479	0.470 ± 0.200	0.0312
VDS(s^-1)	0.317± 0.262	0.097 ± 0.093	0.0075
VDS/MVED	0.440 ± 0.295	0.231 ± 0.252	0.0703

	MD		MVED		VDS		VDS/MVED
	Univariate	Multiple Linear Regression	Univariate	Multiple Linear Regression	Univariate	Multiple Linear Regression	Univariate	Multiple Linear Regression
Age	0.087		0.059		0.912		0.130
Gender	0.070		0.272		0.819	0.04	0.705
LV mass	< 0.001	< 0.001	< 0.001	0.001	0.001	< 0.001	0.002	0.003
LVEDV	< 0.001		< 0.001		0.366		0.154
LVESV	< 0.001		< 0.001		0.605		0.083
LVEF	0.002		< 0.001		0.610		0.004	0.006
HR	0.886		0.645		< 0.001	0.081	0.025
SBP	0.140		0.028		0.399		0.051
DBP	0.190		0.616		0.846		0.232

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