Echocardiography has been the foundation for the assessment of left ventricular (LV) diastolic function. This review describes the potential role for cardiac magnetic resonance (CMR) imaging for the assessment of LV diastolic function, and among patients with heart failure with preserved ejection fraction (HFpEF). The following are points to remember:

Several indices of LV diastolic function used can be derived from CMR:

• LV mass and LV hypertrophy: Data from the MESA (Multi-Ethnic Study of Atherosclerosis) suggest that CMR-based LV mass above the 95th percentile is associated with incident heart failure (HF).
• LV time-volume filling curves: Although time consuming and not routinely used in clinical practice, LV filling profile curves (change in volume over time) and diastolic volume recovery (the percentage of diastole required for recovery of 80% of the stroke volume) can be correlated to echo/Doppler diastolic dysfunction.
• Phase contrast CMR (PC-CMR): PC-CMR imaging can be used for flow assessment across the mitral orifice (albeit with a temporal resolution of 30-40 ms) for transmitral E and A waves, and for pulmonary vein flow. CMR can be used to assess the mitral septal tissue velocity in early diastole (e’).
• LV strain: LV deformation (strain, strain rate, torsion) can be assessed on CMR using myocardial tagging, PC-CMR velocity encoding, and feature-tracking CMR (FT-CMR).
• T1 mapping, extracellular volume (ECV): CMR using T1 mapping and ECV can provide tissue characterization and help with the early detection of myocardial pathologies that can be present among patients with clinical HFpEF.
• Left atrial (LA) volume, LA function, and LA strain: CMR can be used to determine maximal LA volume, measures of LA function (reservoir, conduit, pumping), and LA deformation.

CMR in the evaluation of patients with HFpEF:

• Other pathologies can be present among patients diagnosed with HFpEF. CMR can be useful in the detection of coronary artery disease, microvascular dysfunction, hypertrophic cardiomyopathy, infiltrative diseases, and constrictive pericarditis.
• High frequency magnetic resonance elastography (MRE) can be used to assess myocardial stiffness.

The assessment of LV diastolic function using CMR is feasible, but it has yet to be employed in routine clinical care. There is a need for more standardized post-processing software to permit the widespread application of CMR to the assessment of LV diastolic function.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pericardial Disease, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Echocardiography/Ultrasound, Magnetic Resonance Imaging

Keywords: Atrial Function, Left, Cardiomyopathy, Hypertrophic, Coronary Artery Disease, Diastole, Echocardiography, Echocardiography, Doppler, Diagnostic Imaging, Elasticity Imaging Techniques, Heart Failure, Hypertrophy, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Pericarditis, Constrictive, Stroke Volume, Ventricular Function, Left

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