Comparison of Magnetic Resonance Imaging Versus Doppler Echocardiography for the Evaluation of Left Ventricular Diastolic Function in Patients With Cardiac Amyloidosis

To assess the role of magnetic resonance imaging (MRI) in the assessment of diastolic function, diastolic mitral inflow parameters using MRI and transthoracic Doppler echocardiography (echocardiography) were compared in patients with cardiac amyloidosis. Thirty-eight patients (age 60 ± 12 years; 32% women) in sinus rhythm with cardiac amyloidosis (biopsy-proven systemic amyloidosis and positive echocardiographic and contrast-enhanced cardiac MRI findings) were evaluated. Cine phase-contrast MRI images of mitral inflow were obtained in the left ventricle to quantify diastolic blood flow. MRI measurements of diastolic parameters were compared (Spearman's rank correlation) with echocardiographic diastolic mitral inflow velocity parameters. Additional analysis was performed comparing MRI findings in patients with a restrictive echocardiographic diastolic filling pattern (n = 23) versus those without (n = 15). For the 38 patients, early diastolic (E) peak velocity was 61 ± 26 cm/s using MRI versus 79 ± 21 using echocardiography (Spearman's rank correlation 0.55, p = 0.0004), and late diastolic (A) peak velocity was 46 ± 22 cm/s using MRI versus 47 ± 22 cm/s using echocardiography (Spearman's rank correlation 0.54, p = 0.0005). E/A ratio was 1.55 ± 0.9 using MRI and 2.25 ± 1.4 using echocardiography (Spearman's rank correlation 0.75, p <0.0001). Deceleration times in both modalities showed good correlation (MRI, 180 ± 44 ms vs echocardiography, 179 ± 49; Spearman's rank correlation 0.61, p = 0.0001). MRI E/A ratio for peak velocities was significantly higher in patients with restrictive echocardiographic patterns (1.95 ± 1.0) versus those without (0.93 ± 0.3; p = 0.0003). Two of 23 patients with a restrictive echocardiographic pattern had an MRI E/A ratio <1. In conclusion, mitral inflow peak velocities, deceleration times, and E/A ratios detected using phase-contrast MRI in patients with cardiac amyloidosis showed moderately good correlation with echocardiography and identified most patients with restrictive echocardiographic patterns.