Published Online
on September 21, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

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

Keigo Kawaji; Noel C.F. Codella; Martin R. Prince; Christopher W. Chu; Aqsa Shakoor; Troy M. LaBounty; James K. Min; Rajesh V. Swaminathan; Richard B. Devereux; Yi Wang and Jonathan W. Weinsaft¹

Weill Cornell Medical College, New York, NY

^* Corresponding author; email: jww2001{at}med.cornell.edu

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—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 (E:A) ratios, peak diastolic filling rate (PFR), time to peak filling rate (TPFR), 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 vs. without diastolic dysfunction had lower E:A ratios, longer TPFR, lower stroke volume adjusted PFR, and greater DVR (all p<0.05). Prevalence of abnormal CMR filling indices increased in relation to clinical symptoms classified by NYHA functional class (p=0.04) or dyspnea (p=0.006). Among all parameters tested, DVR yielded optimal performance vs. echo (AUC: 0.87±0.04, p<0.001); Using a 90% specificity cutoff, DVR yielded 74% sensitivity for diastolic dysfunction. In multivariate analysis, DVR (OR 1.82, CI 1.13-2.57, p=0.02) was independently associated with echo-evidenced diastolic dysfunction after controlling for age, hypertension, and LV mass (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 is associated with echo-evidenced diastolic dysfunction independently of clinical and imaging variables.

Key Words: echocardiography • magnetic resonance imaging • diastolic dysfunction