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Going beyond ejection fraction - CMR assessment of ventricular-vascular coupling and LV remodeling predicts diastolic dysfunction in advanced ischemic cardiomyopathy

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Journal of Cardiovascular Magnetic Resonance201315 (Suppl 1) :P193

  • Published:


  • Cardiac Magnetic Resonance
  • Diastolic Dysfunction
  • Pulse Wave Velocity
  • Balance Steady State Free Precession
  • Cardiac Magnetic Resonance Study


Increased ventricular and arterial stiffness is associated with diastolic dysfunction (DDFx) in patients with heart failure and preserved systolic function. Limited information is available regarding the impact of aortic biomechanics and the ventricular-vascular coupling (VVC) on DDFx in those patients with advanced ischemic cardiomyopathy (ICM). In addition, it is not known if cardiac magnetic resonance (CMR) measurements of LV remodeling (sphericity and scar burden) can also contribute to prediction of DDFx in these patients. We sought to examine the relationship between aortic biomechanical properties (ascending and descending distensibility, arch pulse wave velocity), ventricular-ventricular coupling (defined as the ratio between LV end-systolic elastance and effective arterial elastance), LV remodeling assessed by CMR and diastolic function assessed by echocardiography in patients with advanced ICM.


Patients were selected if they had undergone TTE and CMR studies within 7 days (median=1 day). 354 patients with LVEF ≤ 40% and ≥ 70% stenosis in ≥1 coronary artery but without prior mitral valve surgery, fused E/A waves, atrial fibrillation or > moderate mitral regurgitation were screened. Of those, 84 patients were excluded due to poor CMR image quality from artifacts and/or suboptimal temporal resolution. A total 270 charts were reviewed for demographic and laboratorial data. Diastolic function assessment was performed as per guidelines. Aortic biomechanics were measured using previously validated software (ARTFUN, INSERM U678, Paris, France) using semi-automated tracing of aortic contours with phase-contrast images and through-plane velocity encoding of the ascending and descending aorta. CMR evaluation also included long and short axis assessment of LV sphericity and function respectively on balanced steady state free precession images along with assessment of myocardial scar (on phase-sensitive inversion recovery DHE-CMR sequence ~ 10-20 minutes). Multivariate linear regression analysis was done to identify the independent predictors of DDFx.


Males represented 76% of the cohort with a mean age of 62 ± 10 years. Mean LVEF was 23 ± 5% and DDFx was classified as either: stage 1 (44%), stage 2 (25%) or stage 3 (31%). The independent predictors of impaired diastolic function (stage > 1) are listed on Table 1.
Table 1

Multivariate predictors of LV diastolic dysfunction (*)


Unstandardized Coefficients

Standardized Coefficients


95.0% Confidence Interval for B

Linear Regression Model


Std Error


P value

Lower Bound

Upper Bound








Diabetes Mellitus







Vena contracta














Gender male







LV Sphericity







Scar Burden (#)







(*) After adjusting for age, hypertension, dyslipidemia, QRS duration, ascending and descending aorta distensibility, arch PWV, end-systolic volume index, body surface area, LV mss index, coronary artery disese severity, scar burden. VVC = ventricular-vascular coupling. (#) Scar burden was assessed using the 17-segment left ventricular model.


In patients with advanced ICM, CMR assessment of VVC, LV sphericity and scar burden are independent predictors of DDFx. Aortic biomechanical properties are not independently associated with diastolic dysfunction.



Authors’ Affiliations

Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia


© Cavalcante et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.