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.