Myocardial dysfunction in patients with aortic stenosis and hypertensive heart disease assessed by MR tissue phase mapping

• Published in: Journal of magnetic resonance imaging Vol. 44; no. 1; pp. 168 - 177
• Main Authors: von Knobelsdorff-Brenkenhoff, Florian, Hennig, Pierre, Menza, Marius, Dieringer, Matthias A., Foell, Daniela, Jung, Bernd, Schulz-Menger, Jeanette
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2016; Wiley Subscription Services, Inc
• Subjects: Algorithms; aortic stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Cardiac Imaging Techniques - methods; Cardiovascular disease; Electrocardiography; exercise; Female; Humans; hypertension; Hypertension - complications; Hypertension - diagnostic imaging; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; myocardial deformation; Reproducibility of Results; Sensitivity and Specificity; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; exercise; magnetic resonance; aortic stenosis; hypertension; myocardial deformation
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.25125

Purpose To identify abnormalities of myocardial velocities in patients with left ventricular pressure overload using magnetic resonance tissue phase mapping (TPM). Material and Methods Thirty‐three patients (nine with hypertensive heart disease [HYP], 24 with aortic stenosis [AS]) and 41 healthy controls were enrolled. To assess left ventricular motion, a basal, midventricular, and apical slice were acquired using three‐directional velocity‐encoded phase‐contrast MR with a 3T system. Target parameters were peak longitudinal (Vz) and radial (Vr) velocity in systole and diastole (Peaksys, Peakdias). Analysis was done on each myocardial segment. In a subgroup (n = 7 HYP, n = 12 AS, n = 24 controls), measurement was repeated during handgrip exercise. Results AS had significantly lower Vz‐Peaksys in the inferolateral and inferoseptal wall (P = 0.003–0.029) and Vr‐Peaksys in the septum and anterior wall (P = 0.001–0.013) than controls. Vz‐Peakdias and Vr‐Peakdias were lower in AS than in controls in almost all segments (P < 0.001–0.028). HYP showed reduced Vz‐Peakdias compared to controls in all basal segments as well as in the lateral midventricular wall (P < 0.001–0.045), and reduced Vr‐Peakdias compared to controls predominantly in the midventricular and apical segments (P = 0.004–0.042). AS patients with focal fibrosis had significantly reduced myocardial velocities (P = 0.001–0.047) in segments without late enhancement. During exercise, Vz‐Peaksys, Vr‐Peaksys, and Vz‐Peakdias remained unchanged in AS and HYP, but decreased in the lateral wall in controls (P < 0.001–0.043). Conclusion Even with preserved left ventricle (LV) ejection fraction, peak longitudinal and radial velocities of the LV are reduced in AS and HYP, indicating early functional impairment. J. Magn. Reson. Imaging 2016;44:168–177.