Learning objectives
To analyze the role of CMR in the assessment of left ventricle (LV) diastolic dysfunction;
To describe the most used cardiac MR imaging tools for measurement of LV diastolic function.
Background
While the assessment of LV systolic dysfunction has been well investigated by the evaluation of ejection fraction (EF),
diastolic dysfunction characterization is evidently more difficult.
However,
the importance of the assessment of diastolic dysfunction has been increased in last decades,
because is thought to play a crucial role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF),
the previously described “diastolic HF”,
and it has prognostic implications even in the preclinical stage.
By definition,
diastolic HF is a clinical entity and its diagnosis...
Findings and procedure details
LV diastolic dysfunction occurs in several cardiac and systemic diseases which involve abnormalities of active ventricular relaxation and passive ventricular compliance,
leading to ventricular stiffness.
Several factors can cause LV stiffness including age,
increased LV wall thickness relative to cavity size (such as in hypertension,
aortic stenosis or hypertrophic cardiomyopathy),
intracellular changes in microtubules,
extracellular changes in collagen and infiltration (such as in amyloidosis or sarcoidosis).
Other less common causes of stiffness and impaired LV relaxation are idiopathic restrictive myocarditis,
storage disease (hemochromatosis,
Fabry disease)...
Conclusion
CMR allows an excellent evaluation of diastolic dysfunction,
highlighting underlying etiology.
In particular,
non-contrast CMR provides a detailed assessment of diastolic parameters,
while contrast CMR can gives further information on various myocardial infiltrative processes.
Furthermore,
newer techniques will increase sensitivity and accuracy ofCMR diagnosisallowing the preclinical stratification and subsequent follow-up of these Patients.
References
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Beladan CC,
Iliesiu AM,
Popescu AC,
Coman IM,
Ginghina C,
Popescu BA.
(2016).
Imaging assessment of left ventricular diastolic function: current and emerging methods.Acta cardiologica,71(4),
379-388.
Leong DP,
De Pasquale CG,
Selvanayagam JB.
(2010).
Heart failure with normal ejection fraction: the complementary roles of echocardiography and CMR imaging.JACC: Cardiovascular Imaging,3(4),
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Wan SH,
Vogel MW Chen HH.
(2014).
Pre-clinical diastolic dysfunction.Journal of the American College...