Evaluation of left ventricular diastolic function in patients with coronary microvascular dysfunction via cardiovascular magnetic resonance feature tracking

Huihui Kong; Jiaxin Cao; Jinfan Tian; Jingwen Yong; Jing An; Lijun Zhang; Xiantao Song; Yi He

doi:10.21037/qims-23-47

Evaluation of left ventricular diastolic function in patients with coronary microvascular dysfunction via cardiovascular magnetic resonance feature tracking

Quant Imaging Med Surg. 2023 Oct 1;13(10):7281-7293. doi: 10.21037/qims-23-47. Epub 2023 Sep 11.

Authors

Huihui Kong¹, Jiaxin Cao¹, Jinfan Tian², Jingwen Yong², Jing An³, Lijun Zhang⁴, Xiantao Song², Yi He¹

Affiliations

¹ Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
² Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
³ Siemens Shenzhen Magnetic Resonance, MR Collaboration NE Asia, Shenzhen, China.
⁴ Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Coronary microvascular dysfunction (CMD) has been suggested to be one of the pathologic mechanisms contributing to heart failure with preserved left ventricular ejection fraction (LVEF) and left ventricular (LV) diastolic dysfunction. We therefore aimed to evaluate LV diastolic function in patients with CMD using cardiovascular magnetic resonance feature tracking (CMR-FT).

Methods: We prospectively enrolled 115 patients referred to cardiology clinics for chest pain assessment who subsequently underwent coronary computed tomography angiogram and stress perfusion CMR. CMD was defined as the presence of subendocardial inducible ischemia detected through visual assessment. LV diastolic function was evaluated using CMR-derived volume-time curves and CMR-FT parameters. The former included early peak filling rate (PFR) and time to PFR; the latter included LV global/regional peak longitudinal diastolic strain rate (LDSR), circumferential diastolic strain rate (CDSR), and radial diastolic strain rate (RDSR).

Results: A total of 92 patients with 1,312 segments were eventually included. Of these, 19 patients were classified as non-CMD (48.8±11.2 years; 63.2% male) and 73 as with CMD (52.3±11.9 years; 54.8% male). The LVEFs were similar and preserved in both groups (P=0.266). At the per-patient level, no differences were observed in PFR, time to PFR, or LV global diastolic strain rates between the two groups. At the per-segment level, 51% (665/1,312) of the myocardial segments were classified as CMD, whereas 49% (647/1,312) were classified as non-CMD. CMD segments showed significantly lower regional CDSR (P=0.019) and RDSR (P=0.006) compared with non-CMD segments.

Conclusions: Despite normal LV ejection fraction in CMD patients, decreased LV diastolic function in CMD myocardial segments indicates early diastolic impairment.

Keywords: Left ventricular diastolic function (LV diastolic function); cardiovascular magnetic resonance feature tracking (CMR-FT); coronary microvascular dysfunction (CMD).