Non-invasive estimation of increased LV filling pressures in LV hypertrophy with normal systolic function: Comparison between CMR and Doppler, validated by invasive PCWP measurements

Introduction

Transmitral flow is unreliable for the estimation of left ventricular (LV) filling pressures in hypertrophy and normal systolic function. Mitral early peak filling velocity E divided by mitral annulus early peak velocity Ea (E/Ea) and global diastolic strain rate (SR) during peak filling provide a relatively load independent measurement of global myocardial performance.

Purpose

We aimed to compare Doppler and cardiovascular magnetic resonance (CMR) assessed E/Ea and non-tagged CMR assessed global diastolic SR for the estimation of filling pressure, in comparison with invasive measurement.

Methods

Sixteen patients with hypertensive heart disease (LV mass index: 111 ± 18 g/m²), absence of valvular regurgitation and with normal systolic function (LV ejection fraction: 67 ± 7 %) referred for cardiac catheterization were studied. Measurement of mitral flow and mitral annulus velocities were performed by Doppler and phase-contrast CMR. CMR derived global longitudinal and global volumetric SR during early peak filling was measured using long-axis cine CMR images. These data were validated by catheter based mean pulmonary capillary wedge pressure (PCWP).

Results

Mitral flow E/A had no significant correlation with mean PCWP. E/Ea (Doppler r= 0.74, p<0.01 and CMR r=0.56, p<0.05), longitudinal diastolic SR (r=0.65, p<0.01) and long-axis volumetric diastolic SR (r=0.51, p<0.05) related to invasively measured mean PCWP.

Best prediction of elevated mean PCWP was performed by Doppler assessed E/Ea (sensitivity 75%, specificity: 100%, area under the curve: 0.88, p<0,05). CMR assessed E/Ea, longitudinal volumetric diastolic SR and long-axis volumetric diastolic SR had similar sensitivity (respectively 75%, 87.5 % and 75 %), specificity (respectively 75%, 62.5 % and 87.5 %) and area under the curve (respectively 0.80, 0.80 and 0.80, p<0.05) for the prediction of elevated mean PCWP.

Conclusions

Non-invasive estimation of increased LV filling pressures in LV hypertrophy with normal systolic function can be performed with CMR and Doppler techniques. Doppler assessed E/Ea provided best prediction of elevated LV filling pressure.