Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Diastolic Function in Patients with Hypertrophic Cardiomyopathy: Evaluation Using the Phase-contrast MRI Measurement of Mitral Valve and Pulmonary Vein Flow Velocities

비대성심근증 환자의 이완기능평가: 승모판과 폐정맥 유속을 측정한 위상차 MRI의 이용

  • Kim, Eun Young (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Yeon Hyeon (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sung Mok (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Sang-Chol (Division of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Sung-A (Division of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Jae K. (Division of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김은영 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 최연현 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김성목 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 이상철 (성균관대학교 의과대학 삼성서울병원 순환기내과) ;
  • 장성아 (성균관대학교 의과대학 삼성서울병원 순환기내과) ;
  • 오재건 (성균관대학교 의과대학 삼성서울병원 순환기내과)
  • Received : 2014.08.25
  • Accepted : 2014.10.01
  • Published : 2014.12.31
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Abstract

Purpose: Diastolic dysfunction is a common problem in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to assess the role of MRI in the assessment of diastolic function using mitral valve and pulmonary vein flow velocities in HCM patients. Methods and Results: Phase-contrast MRI (mitral valve and pulmonary vein) and transthoracic echocardiography was successfully performed for 59 HCM patients (44 men and 15 women; mean age, 51 years). Forty-nine patients had a diastolic dysfunction; grade 1 (n = 20), grade 2 (n = 27), and grade 3 (n = 2) using echocardiography, and ten patients had normal diastolic function. The transmitral inflow parameters (E, A, and E/A ratios) obtained by MRI showed positive correlation with the same parameters measured by echocardiography (Pearson's r values were 0.47, 0.60, and 0.75 for E, A, E/A, respectively, all P < 0.001). With the flow information of the pulmonary vein from cardiac MRI, pseudo-normalized pattern (n = 8) could be distinguished from true normal filling pattern (n = 17), and the diastolic function grades by cardiac MRI showed moderate agreement with those of echocardiography (kappa value = 0.45, P < 0.001). Conclusions: Assessment of left ventricle diastolic function is feasible using phase-contrast MRI in HCM patients. Analysis of pulmonary vein flow velocity on MRI is useful for differentiating pseudo-normal from normal diastolic function in HCM patients.

배경: 심장의 이완기능 이상은 비대성심근증 환자에서 흔히 발견되는 문제이다. 본 연구는 비대성심근증 환자의 심장 이완기능을 평가하는 데 있어, 승모판과 폐정맥의 유속을 이용한 MRI의 역할을 알아보고자 하였다. 방법과 결과: 승모판과 폐정맥의 유속을 이용한 위상차 MRI와 심초음파검사가 59명 (남:여 = 44:15, 평균 연령 = 51세)의 비대성심근증 환자에서 시행되었다. 49명의 환자가 심초음파검사에서 다양한 정도의 심장 이완기능 이상을 보였다; grade 1 (20명), grade 2 (27명), and grade 3 (2명). MRI로 계산한 승모판 유속인자들 (E, A, E/A ratios)은 심초음파검사로 구한 동일 인자들과 양의 상관관계를 보였다 (Pearson's r values = 0.47, 0.60, 0.75 for E, A, E/A, respectively, all P < 0.001). MRI로 폐정맥 유속정보를 이용하는 경우, pseudo-normalized pattern (8명)이 정상 충만 양상(filling pattern) (17명)과 구분될 수 있었고, 이들을 이용하여 이완기능 정도를 평가를 하는 경우, 심장 MRI가 심초음파검사와 중등도의 일치도를 보였다 (kappa value = 0.45, P < 0.001). 결론: 비대성심근증 환자에서 위상차 MRI를 이용한 심장 이완기능 평가는 임상적으로 적용 가능한 방법이며, 폐정맥 유속 분석을 추가하는 경우, 정상과 pseudo-normal을 구분하는데 유용하다.

Keywords

References

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