Research article
Differences in left ventricular and left atrial function assessed during breath-holding and breathing

https://doi.org/10.1016/j.ejrad.2021.109756Get rights and content
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Highlights

  • LV systolic and diastolic function parameters differ between inspiratory breath-holding and free breathing acquisition.

  • Left atrial volumetric function parameters differ between inspiratory breath-holding and free breathing acquisition.

  • Differences between inspiratory breath-holding and breathing functional parameters show considerable variations within individuals.

Abstract

Purpose

To analyze differences in systolic and diastolic left ventricular (LV) as well as left atrial (LA) function parameters obtained from identical cardiac magnetic resonance (MR) imaging techniques during inspiratory breath-holding and breathing (breath-hold to breathing differences).

Method

56 subjects without signs of heart failure (23/33 male/female, age 58 ± 14 years) underwent 3 T MR cine real-time and transmitral phase contrast imaging with the same spatial and temporal resolution during inspiratory breath-holding and free breathing. LV and LA volumetric function parameters were derived from segmentation of cine series, transmitral peak velocities and early-diastolic myocardial peak velocity from phase contrast series. Corresponding breath-hold and breathing parameters were compared by Bland-Altman analysis; repeatability of breath-hold and breathing measurements was quantified by variance component analysis. p < 0.05 was regarded as statistically significant.

Results

Mean differences between results obtained during inspiratory breath-holding vs. breathing were significant for LV volumetric function (end-diastolic volume=−7 mL, p = 0.002; end-systolic volume=−7 mL, p < 0.001; ejection fraction = 3 %, p < 0.001; peak ejection rate = 22 mL/s, p = 0.002; early-diastolic peak filling rate=−34 mL/s, p = 0.025), LA volumetric function (maximum volume=-6 mL, p < 0.001; total ejection fraction=-4%, p < 0.001; active ejection fraction=-2%, p = 0.013; before contraction ejection fraction=-4%, p < 0.001) and early-diastolic velocities (transmitral=-6 cm/s, p < 0.001; tissue velocity=-1.8 cm/s, p < 0.001). Standard deviations of breath-hold-to-breathing differences exceeded the corresponding repeatabilities of breath-hold and breathing measurements.

Conclusions

Systolic and diastolic LV and LA function parameters acquired during inspiratory breath-holding and breathing differ, and large inter-individual breath-hold-to-breathing variations are possible. Thus, the breathing state should be taken into account, especially when comparing results in patient follow-up acquired in different respiratory states.

Abbreviations

A
late-diastolic transmitral peak filling velocity
bSSFP
balanced steady-state free-precession
MRI
magnetic resonance imaging
E
early-diastolic transmitral peak filling velocity
e’
early-diastolic myocardial peak velocity
ECG-gated
electrographically gated
EDV
left ventricular end-diastolic volume
EF
left ventricular ejection fraction
EFactive
active left atrial ejection fraction
EFpassive
passive left atrial ejection fraction
EFtotal
total left atrial ejection fraction
ESV
left ventricular end-systolic volume
FA
late-diastolic transmitral peak flow
FE
early-diastolic transmitral peak flow
GLS
global longitudinal strain
ICC
intraclass correlation coefficient
LA
left atrium
LAbc
left atrial volume before atrial contraction
LAmax
maximal left atrial volume
LAmin
minimal left atrial volume
LV
left ventricle
PER
left ventricular peak ejection rate
PFRA
late-diastolic left ventricular peak filling rate
PFRE
early-diastolic left ventricular peak filling rate
r
Pearson's correlation coefficient
RR-interval
cardiac interval
SD
standard deviation
SV
left ventricular stroke volume

Keywords

Magnetic resonance imaging
Atrial function, left
Ventricular function, left
Breath holding
Respiration

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