Feasibility of early detection of left ventricular diastolic dysfunction in hypertensive patients using four-dimensional flow cardiac magnetic resonance.

OBJECTIVES: To identify whether early left ventricle diastolic dysfunction(LVDD) in hypertension (HTN), with or without left ventricular hypertrophy (LVH), can be detected by four-dimensional flow cardiac magnetic resonance (4D flow CMR).

METHODS: Sixty-six HTN patients and thirty age-/gender matched healthy controls were retrospectively analyzed. The HTN patients were divided into the LVH and non-LVH subgroup, and were further divided into LVDD and non-LVDD subgroup according to a multiparametric echocardiographic assessment incorporating E/e', E/A ratio, and LA diameter(LAd). 4D flow-derived left ventricular (LV) kinetic energy (KE) parameters were calculated and indexed to LV end-diastolic volume (EDV), including KEiEDV during systole, early diastole, and late diastole, as well as in-plane KE(%) and the time difference (TD) of peak E-wave KE propagation. KE parameters were compared among healthy controls, HTN patients with LVDD, and HTN patients without LVDD, as well as between LVH and non-LVH subgroups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of KE parameters for detecting LVDD.

RESULTS: HTN patients showed significantly altered KE patterns compared with controls, characterized by decreased E-wave KEiEDV and KE E/A ratio and increased A-wave KEiEDV, in-plane KE(%), and TD (all P < 0.01), with similar findings in the non-LVH subgroup. For LVDD detection, the KE E/A ratio demonstrated the best diagnostic accuracy among all evaluated KE and conventional CMR parameters, with an AUC of 0.801 in the overall HTN cohort and 0.805 in the non-LVH subgroup, comparable to E/e' (AUC = 0.810).

CONCLUSIONS: The KE E/A ratio derived from 4D flow CMR is comparable to E/e' for detecting early LVDD in HTN patients, and remains effective even in the absence of LVH.