Index of biventricular interdependence calculated using cardiac MRI: a proof of concept study in patients with and without constrictive pericarditis

• Published in: The International Journal of Cardiovascular Imaging Vol. 29; no. 2; pp. 363 - 369
• Main Authors: Anavekar, Nandan S., Wong, Benjamin F., Foley, Thomas A., Bishu, Kalkidan, Kolipaka, Arunark, Koo, Chi Wan, Khandaker, Masud H., Oh, Jae K., Young, Phillip M.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.02.2013; Springer Nature B.V
• Subjects: Adult; Aged; Cardiac Imaging; Cardiology; Hemodynamics; Humans; Imaging; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Middle Aged; Myocardium - pathology; Observer Variation; Original Paper; Pericarditis, Constrictive - diagnosis; Pericarditis, Constrictive - pathology; Pericarditis, Constrictive - physiopathology; Predictive Value of Tests; Radiology; Reproducibility of Results; Retrospective Studies; Stroke Volume; Time Factors; Ventricular Function, Left; Ventricular Function, Right; Constrictive pericarditis; Index; Ventricular interdependence
• ISSN: 1569-5794; 1875-8312; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-012-0101-x

We sought to propose a magnetic resonance (MR) imaging-derived index of biventricular interdependence as a diagnostic parameter to distinguish patients with surgically-confirmed pericardial constriction from those without. Free-breathing real time MR pulse sequences of seventeen subjects with surgically proven constrictive pericarditis and thirty-five patients referred for clinically-indicated cardiac MR examinations but without documented constriction were analyzed using a novel index of biventricular interdependence. Cross-sectional biventricular areas at end diastole using the epicardial surface were traced at the mid left ventricular level at end-inspiration and end-expiration and an index of biventricular interdependence, defined as the ratio of (biventricular end-diastolic area at end-inspiration)/(biventricular end-diastolic area at end-expiration) was calculated for each subject. The mean index for both groups was calculated and results were statistically compared. The index of biventricular interdependence approximated unity (mean index 1.03 ± 0.03 SD) in patients with surgically confirmed pericardial constriction, indicating similar biventricular area at end-inspiration and end-expiration, and was significantly lower than in individuals without constrictive pericarditis (mean index 1.28 ± 0.10 SD; p  < 0.0001). The MR-derived index of biventricular interdependence was significantly different between subjects with surgically-confirmed pericardial constriction and subjects where pericardial constraint was not suspected and may serve as a useful metric in the hemodynamic assessment of patients with a potential diagnosis of constrictive pericarditis.