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Reiter C, Reiter G, Kräuter C, Kolesnik E, Greiser A, Scherr D, Schmidt A, Fuchsjäger M, Reiter U. Impact of the evaluation method on 4D flow-derived diastolic transmitral and myocardial peak velocities: Comparison with echocardiography. Eur J Radiol 2024; 170:111247. [PMID: 38071909 DOI: 10.1016/j.ejrad.2023.111247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/07/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To compare agreement of different evaluation methods of magnetic resonance (MR) 4D flow-derived diastolic transmitral and myocardial peak velocities as well as their ratios, using echocardiography as reference. METHODS In this prospective study, 60 subjects without symptoms of cardiovascular disease underwent echocardiography and non-contrast 3 T MR 4D flow imaging of the heart. Early- (E) and late-diastolic (A) transmitral peak filling velocities were evaluated from 4D flow data using three different strategies: 1) at the mitral valve tips in short-axis orientation (SA-method), 2) between the mitral valve tips in 4-chamber orientation (4-chamber-method), and 3) as maximal velocities in the transmitral inflow volume (max-velocity-method). Septal, lateral and average early-diastolic myocardial peak velocities (e') were derived from the myocardial tissue in the vicinity of the mitral valve. 4D flow parameters were compared with echocardiography by correlation and Bland-Altman analysis. RESULTS All 4D flow-derived E, A and E/A values correlated with echocardiography (r = 0.65-0.73, 0.75-0.83 and 0.74-0.86, respectively). While the SA- and 4-chamber-methods substantially underestimated E and A compared to echocardiography (p < 0.001), the max-velocity-method provided E (p = 0.13) and E/A (p = 0.07) without significant bias. Septal, lateral and average e' from 4D flow as well as the max-velocity-method-derived E/e' correlated with echocardiographic measurements (r = 0.64-0.81) and showed no significant bias (p = 0.26-0.54). CONCLUSION MR 4D flow imaging allows precise and accurate evaluation of transmitral and myocardial peak velocities for characterization of LV diastolic function without significant bias to echocardiography, when transmitral velocities are assessed from the transmitral inflow volume. This enables the use of validated echocardiography threshold values.
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Affiliation(s)
- Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Division of Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | | | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
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Assadi H, Li R, Grafton-Clarke C, Uthayachandran B, Alabed S, Maiter A, Archer G, Swoboda PP, Sawh C, Ryding A, Nelthorpe F, Kasmai B, Ricci F, van der Geest RJ, Flather M, Vassiliou VS, Swift AJ, Garg P. Automated 4D flow cardiac MRI pipeline to derive peak mitral inflow diastolic velocities using short-axis cine stack: two centre validation study against echocardiographic pulse-wave doppler. BMC Cardiovasc Disord 2023; 23:24. [PMID: 36647000 PMCID: PMC9843884 DOI: 10.1186/s12872-023-03052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Measurement of peak velocities is important in the evaluation of heart failure. This study compared the performance of automated 4D flow cardiac MRI (CMR) with traditional transthoracic Doppler echocardiography (TTE) for the measurement of mitral inflow peak diastolic velocities. METHODS Patients with Doppler echocardiography and 4D flow cardiac magnetic resonance data were included retrospectively. An established automated technique was used to segment the left ventricular transvalvular flow using short-axis cine stack of images. Peak mitral E-wave and peak mitral A-wave velocities were automatically derived using in-plane velocity maps of transvalvular flow. Additionally, we checked the agreement between peak mitral E-wave velocity derived by 4D flow CMR and Doppler echocardiography in patients with sinus rhythm and atrial fibrillation (AF) separately. RESULTS Forty-eight patients were included (median age 69 years, IQR 63 to 76; 46% female). Data were split into three groups according to heart rhythm. The median peak E-wave mitral inflow velocity by automated 4D flow CMR was comparable with Doppler echocardiography in all patients (0.90 ± 0.43 m/s vs 0.94 ± 0.48 m/s, P = 0.132), sinus rhythm-only group (0.88 ± 0.35 m/s vs 0.86 ± 0.38 m/s, P = 0.54) and in AF-only group (1.33 ± 0.56 m/s vs 1.18 ± 0.47 m/s, P = 0.06). Peak A-wave mitral inflow velocity results had no significant difference between Doppler TTE and automated 4D flow CMR (0.81 ± 0.44 m/s vs 0.81 ± 0.53 m/s, P = 0.09) in all patients and sinus rhythm-only groups. Automated 4D flow CMR showed a significant correlation with TTE for measurement of peak E-wave in all patients group (r = 0.73, P < 0.001) and peak A-wave velocities (r = 0.88, P < 0.001). Moreover, there was a significant correlation between automated 4D flow CMR and TTE for peak-E wave velocity in sinus rhythm-only patients (r = 0.68, P < 0.001) and AF-only patients (r = 0.81, P = 0.014). Excellent intra-and inter-observer variability was demonstrated for both parameters. CONCLUSION Automated dynamic peak mitral inflow diastolic velocity tracing using 4D flow CMR is comparable to Doppler echocardiography and has excellent repeatability for clinical use. However, 4D flow CMR can potentially underestimate peak velocity in patients with AF.
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Affiliation(s)
- Hosamadin Assadi
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Rui Li
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Ciaran Grafton-Clarke
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Bhalraam Uthayachandran
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Samer Alabed
- grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK ,grid.31410.370000 0000 9422 8284Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ahmed Maiter
- grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK ,grid.31410.370000 0000 9422 8284Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gareth Archer
- grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Peter P. Swoboda
- grid.9909.90000 0004 1936 8403Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Sawh
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Alisdair Ryding
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Faye Nelthorpe
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Bahman Kasmai
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Fabrizio Ricci
- grid.412451.70000 0001 2181 4941Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Rob J. van der Geest
- grid.10419.3d0000000089452978Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcus Flather
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Vassilios S. Vassiliou
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Andrew J. Swift
- grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK ,grid.31410.370000 0000 9422 8284Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pankaj Garg
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK ,grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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