Special Issue: Noninvasive Assessment of Left Ventricular Diastolic Function
State-of-the-Art Review
CMR in the Evaluation of Diastolic Dysfunction and Phenotyping of HFpEF: Current Role and Future Perspectives

https://doi.org/10.1016/j.jcmg.2019.02.031Get rights and content
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Highlights

  • CMR imaging is a promising tool for detecting myocardial disease and assessing structural changes related to HFpEF.

  • Diastolic function parameters derived by CMR are feasible, and gaining increasing awareness.

  • CMR can add value to the diagnostic work-up of HFpEF unmasking alternative pathologies.

  • Faster image acquisition and data processing are needed to gain widespread adoption.

Abstract

Heart failure with preserved ejection fraction presents a challenging diagnosis given a heterogeneous patient population and limited therapeutic options. Diastolic function assessment using echocardiography has been a cornerstone in the work-up and is as important as systolic functional assessment. There has been increased awareness to the potential utility of cardiac magnetic resonance (CMR) imaging over the past decade as a promising, radiation-free, robust imaging modality providing an unrestricted field of view and high-resolution images for global and regional functional assessment. CMR provides early markers for detecting myocardial disease using tissue characterization imaging, which might prove useful to improve diagnosis and management. Over the years, several studies have examined CMR-derived diastolic functional indices, including transmitral and pulmonary venous velocities, left ventricular and left atrial strain using myocardial tagging, and, more recently, feature tracking. The relevance of imaging-based diastolic function indices and their clinical application across different modalities is increasingly recognized.

Key Words

cardiac magnetic resonance
extracellular volume map
feature-tracking CMR imaging
phase-contrast imaging
T1 mapping

Abbreviations and Acronyms

2D
2-dimensional
3D
3-dimensional
4D
4-dimensional
CMR
cardiac magnetic resonance
ECV
extracellular volume
FT-CMR
feature-tracking cardiac magnetic resonance
GLS
global longitudinal strain
HFpEF
heart failure with preserved ejection fraction
HCM
hypertrophic cardiomyopathy
LA
left atrial
LAEF
left atrial ejection fraction
LV
left ventricular
LVEDP
left ventricular end-diastolic pressure
PC-CMR
phase-contrast cardiac magnetic resonance
PCWP
pulmonary capillary wedge pressure
STE
speckle-tracking echocardiography

Cited by (0)

Dr. Shah has received salary support from the National Science Foundation grant (CNS-1646566) and the National Institutes of Health (1R01HL137763-01). All other have reported that they have no relationships relevant to the contents of this paper to disclose.