Automated Segmentation of Routine Clinical Cardiac Magnetic Resonance Imaging for Assessment of Left Ventricular Diastolic Dysfunction

Background-Cardiac magnetic resonance (CMR) is established for assessment of left ventricular (LV) systolic function but has not been widely used to assess diastolic function. This study tested performance of a novel CMR segmentation algorithm (LV-METRIC) for automated assessment of diastolic function. Methods and Results-A total of 101 patients with normal LV systolic function underwent CMR and echocardiography (echo) within 7 days. LV-METRIC generated LV filling profiles via automated segmentation of contiguous short-axis images (204 +/- 39 images, 2: 04 +/- 0: 53 minutes). Diastolic function by CMR was assessed via early: atrial filling ratios, peak diastolic filling rate, time to peak filling rate, and a novel index-diastolic volume recovery (DVR), calculated as percent diastole required for recovery of 80% stroke volume. Using an echo standard, patients with versus without diastolic dysfunction had lower early: atrial filling ratios, longer time to peak filling rate, lower stroke volume-adjusted peak diastolic filling rate, and greater DVR (all P < 0.05). Prevalence of abnormal CMR filling indices increased in relation to clinical symptoms classified by New York Heart Association functional class (P = 0.04) or dyspnea (P = 0.006). Among all parameters tested, DVR yielded optimal performance versus echo (area under the curve: 0.87 +/- 0.04, P < 0.001). Using a 90% specificity cutoff, DVR yielded 74% sensitivity for diastolic dysfunction. In multivariate analysis, DVR (odds ratio, 1.82; 95% CI, 1.13 to 2.57; P = 0.02) was independently associated with echo-evidenced diastolic dysfunction after controlling for age, hypertension, and LV mass (chi(2) = 73.4, P < 0.001). Conclusions-Automated CMR segmentation can provide LV filling profiles that may offer insight into diastolic dysfunction. Patients with diastolic dysfunction have prolonged diastolic filling intervals, which are associated with echo-evidenced diastolic dysfunction independent of clinical and imaging variables. (Circ Cardiovasc Imaging. 2009; 2: 476-484.)