Christoph Guetter

Guetter

Hui Xue

Marie-Pierre Jolly

Orlando P Simonetti

Paaladinesh Thavendiranathan

Weale

Xiaoguang Lu

English

PubMed

Springer - Publisher Connector

Mitral valve annular velocity measurements derived from cine MRI: validation against Doppler echocardiography

WORKSHOP PRESENTATION Open Access
Mitral valve annular velocity measurements
derived from cine MRI: validation against Doppler
echocardiography
Christoph Guetter1*, Paaladinesh Thavendiranathan3,2, Marie-Pierre Jolly1, Xiaoguang Lu1, Hui Xue1,
Orlando P Simonetti2
From 15th Annual SCMR Scientific Sessions
Orlando, FL, USA. 2-5 February 2012
Summary
Assessment of mitral annular tissue velocity plays an
essential role in the evaluation of diastolic dysfunction.
We have previously shown that mitral annular velocities
can be derived from standard four-chamber cine SSFP
images by automatically detecting and tracking the
mitral valve insertion points [1]. However, this method
has not been validated against tissue Doppler echocar-
diography, the standard clinical method for evaluating
diastolic function.
The objective of this study was to assess the accuracy
of early and late diastolic (e’ and a’) mitral annular velo-
cities derived from high temporal resolution SSFP cine
by correlating with tissue Doppler echocardiography.
Background
Assessment of mitral annular tissue velocity plays an
essential role in the evaluation of diastolic dysfunction.
We have previously shown that mitral annular velocities
can be derived from standard four-chamber cine SSFP
images by automatically detecting and tracking the
mitral valve insertion points[1]. However, this method
has not been validated against tissue Doppler echocar-
diography, the standard clinical method for evaluating
diastolic function. The objective of this study was to
assess the accuracy of early and late diastolic (e’ and a’)
mitral annular velocities derived from high temporal
resolution SSFP cine by correlating with tissue Doppler
echocardiography.
Methods
Nine healthy volunteers (5 males, mean age 26.7 yrs)
gave informed consent to undergo CMR and echocar-
diography exams on the same day. Retrospectively and
prospectively gated cine SSFP images in the four-cham-
ber view were acquired during breath-hold on a 3T sys-
tem (Siemens, Tim Trio). Rate 3 acceleration was used
to achieve the following parameters: 17 ms true tem-
poral resolution, 2.0x2.6mmx8mm voxel size, 12-heart-
beat duration. Mitral inflow peak velocity (E) was
measured using retro-gated segmented PC: TR/TE =
4.5/1.9ms, 10mm slice, 100 x 192 matrix, TSENSE
rate=3, VENC=150cm/s, true temporal resolution 36ms.
Trans-thoracic tissue Doppler echocardiography was
used to measure mitral annular tissue velocities and
inflow velocity for 3 heart beats and averaged.
Apex-to-base velocities of the medial and lateral MV
insertion points were estimated from cine SSFP images
by automatic detection[2] and tracking of position over
the entire cardiac cycle using deformable registration[3]
as shown in Figure 1. Manual corrections were applied
in half of the cases where automated tracking was sub-
optimal.
Results
There was good agreement between echo and CMR
mean e’ and a’ velocities and E/e’ ratios (Table 1). Con-
cordance correlation analysis of combined lateral and
medial wall measurements revealed substantial concor-
dance between echo and prospectively triggered (0.64)
and retro-gated (0.61) e’ measurements as well as
between echo and prospectively triggered (0.65) E/e’
measurements. As expected, retrospectively triggered
and retro-gated measurements show strong concordance
1Siemens Corporation, Corporate Research, Princeton, NJ, USA
Full list of author information is available at the end of the article
Guetter et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):W19
http://www.jcmr-online.com/content/14/S1/W19
© 2012 Guetter et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
ranging from 0.81 to 0.91. Although concordance in a’
velocities was poor, the utility of this parameter in clini-
cal practice is not clear.
Conclusions
Despite the small sample size there was substantial con-
cordance between CMR and echo measurement of e’.
This suggests that mitral annular velocity can be mea-
sured accurately and extracted in an automated fashion
from high temporal resolution cine MR acquired in a
reasonable breath-hold time. This method combined
with mitral inflow velocities offers the potential for
CMR to provide important information regarding dia-
stolic function and filling pressures.
Funding
NIH grant RO1 HL 102450;
Figure 1 Mitral valve annulus velocity tracking in prospectively triggered MR (a), (b), mitral inflow velocity (c), and tissue velocities (d) from
Doppler echocardiography. Mean lateral e’ velocities are 11.6 cm/s (echo) and 11.9 cm/s (CMR), and mean lateral a’ velocities are 5.8 cm/s (echo)
and 4.9 cm/s (CMR).
Table 1
Medial Lateral Echocardiography
Acquisition
Technique
e’ a’ e’ a’ E/e’ e’ a’ E/e’
mean ± std
(cm/s)
mean ± std
(cm/s)
mean ± std
(cm/s)
mean ± std
(cm/s)
mean ± std
(cm/s)
Concordance
Corr.
Concordance
Corr.
Concordance
Corr.
Retrospective
CMR
11.29 ± 3.93 3.30 ± 1.34 15.98 ± 4.76 4.51 ± 1.82 5.0 ± 1.3 0.61 -0.09 0.58
Prospective CMR 11.04 ± 2.79 3.95 ± 1.60 15.31 ± 3.92 4.82 ± 1.75 5.1 ± 1.0 0.64 0.03 0.65
Echocardiography 11.62 ± 3.09 6.17 ± 0.86 14.80 ± 3.16 6.24 ± 1.59 5.0 ± 1.3 n/a n/a n/a
Mean e’ and a’ velocities measured at medial and lateral myocardium wall as well as combined lateral and medial E/e’ ratios and concordance correlation
measured from 9 healthy volunteers.
Guetter et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):W19
http://www.jcmr-online.com/content/14/S1/W19
Page 2 of 3
Author details
1Siemens Corporation, Corporate Research, Princeton, NJ, USA. 2Dorothy M.
Davis Heart and Lung Research Institute, The Ohio State University,
Columbus, OH, USA. 3Cleveland Clinic Foundation, Cleveland, OH, USA.
Published: 1 February 2012
References
1. Weale , Guetter , et al: JCMR. 2011.
2. Lu , Georgescu , et al: MICCAI. 2010.
3. Guetter , Chefd’Hotel , et al: ISBI. 2011.
doi:10.1186/1532-429X-14-S1-W19
Cite this article as: Guetter et al.: Mitral valve annular velocity
measurements derived from cine MRI: validation against Doppler
echocardiography. Journal of Cardiovascular Magnetic Resonance 2012 14
(Suppl 1):W19.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Guetter et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):W19
http://www.jcmr-online.com/content/14/S1/W19
Page 3 of 3


Guetter Christoph

Thavendiranathan Paaladinesh

Jolly Marie-Pierre

Lu Xiaoguang

Xue Hui

Simonetti Orlando P

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WORKSHOP PRESENTATION Open AccessMitral valve annular velocity measurementsderived from cine MRI: validation against DopplerechocardiographyChristoph Guetter1*, Paaladinesh Thavendiranathan3,2, Marie-Pierre Jolly1, Xiaoguang Lu1, Hui Xue1,Orlando P Simonetti2From 15th Annual SCMR Scientific SessionsOrlando, FL, USA. 2-5 February 2012SummaryAssessment of mitral annular tissue velocity plays anessential role in the evaluation of diastolic dysfunction.We have previously shown that mitral annular velocitiescan be derived from standard four-chamber cine SSFPimages by automatically detecting and tracking themitral valve insertion points [1]. However, this methodhas not been validated against tissue Doppler echocar-diography, the standard clinical method for evaluatingdiastolic function.The objective of this study was to assess the accuracyof early and late diastolic (e’ and a’) mitral annular velo-cities derived from high temporal resolution SSFP cineby correlating with tissue Doppler echocardiography.BackgroundAssessment of mitral annular tissue velocity plays anessential role in the evaluation of diastolic dysfunction.We have previously shown that mitral annular velocitiescan be derived from standard four-chamber cine SSFPimages by automatically detecting and tracking themitral valve insertion points[1]. However, this methodhas not been validated against tissue Doppler echocar-diography, the standard clinical method for evaluatingdiastolic function. The objective of this study was toassess the accuracy of early and late diastolic (e’ and a’)mitral annular velocities derived from high temporalresolution SSFP cine by correlating with tissue Dopplerechocardiography.MethodsNine healthy volunteers (5 males, mean age 26.7 yrs)gave informed consent to undergo CMR and echocar-diography exams on the same day. Retrospectively andprospectively gated cine SSFP images in the four-cham-ber view were acquired during breath-hold on a 3T sys-tem (Siemens, Tim Trio). Rate 3 acceleration was usedto achieve the following parameters: 17 ms true tem-poral resolution, 2.0x2.6mmx8mm voxel size, 12-heart-beat duration. Mitral inflow peak velocity (E) wasmeasured using retro-gated segmented PC: TR/TE =4.5/1.9ms, 10mm slice, 100 x 192 matrix, TSENSErate=3, VENC=150cm/s, true temporal resolution 36ms.Trans-thoracic tissue Doppler echocardiography wasused to measure mitral annular tissue velocities andinflow velocity for 3 heart beats and averaged.Apex-to-base velocities of the medial and lateral MVinsertion points were estimated from cine SSFP imagesby automatic detection[2] and tracking of position overthe entire cardiac cycle using deformable registration[3]as shown in Figure 1. Manual corrections were appliedin half of the cases where automated tracking was sub-optimal.ResultsThere was good agreement between echo and CMRmean e’ and a’ velocities and E/e’ ratios (Table 1). Con-cordance correlation analysis of combined lateral andmedial wall measurements revealed substantial concor-dance between echo and prospectively triggered (0.64)and retro-gated (0.61) e’ measurements as well asbetween echo and prospectively triggered (0.65) E/e’measurements. As expected, retrospectively triggeredand retro-gated measurements show strong concordance1Siemens Corporation, Corporate Research, Princeton, NJ, USAFull list of author information is available at the end of the articleGuetter et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):W19http://www.jcmr-online.com/content/14/S1/W19© 2012 Guetter et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.ranging from 0.81 to 0.91. Although concordance in a’velocities was poor, the utility of this parameter in clini-cal practice is not clear.ConclusionsDespite the small sample size there was substantial con-cordance between CMR and echo measurement of e’.This suggests that mitral annular velocity can be mea-sured accurately and extracted in an automated fashionfrom high temporal resolution cine MR acquired in areasonable breath-hold time. This method combinedwith mitral inflow velocities offers the potential forCMR to provide important information regarding dia-stolic function and filling pressures.FundingNIH grant RO1 HL 102450;Figure 1 Mitral valve annulus velocity tracking in prospectively triggered MR (a), (b), mitral inflow velocity (c), and tissue velocities (d) fromDoppler echocardiography. Mean lateral e’ velocities are 11.6 cm/s (echo) and 11.9 cm/s (CMR), and mean lateral a’ velocities are 5.8 cm/s (echo)and 4.9 cm/s (CMR).Table 1Medial Lateral EchocardiographyAcquisitionTechniquee’ a’ e’ a’ E/e’ e’ a’ E/e’mean ± std(cm/s)mean ± std(cm/s)mean ± std(cm/s)mean ± std(cm/s)mean ± std(cm/s)ConcordanceCorr.ConcordanceCorr.ConcordanceCorr.RetrospectiveCMR11.29 ± 3.93 3.30 ± 1.34 15.98 ± 4.76 4.51 ± 1.82 5.0 ± 1.3 0.61 -0.09 0.58Prospective CMR 11.04 ± 2.79 3.95 ± 1.60 15.31 ± 3.92 4.82 ± 1.75 5.1 ± 1.0 0.64 0.03 0.65Echocardiography 11.62 ± 3.09 6.17 ± 0.86 14.80 ± 3.16 6.24 ± 1.59 5.0 ± 1.3 n/a n/a n/aMean e’ and a’ velocities measured at medial and lateral myocardium wall as well as combined lateral and medial E/e’ ratios and concordance correlationmeasured from 9 healthy volunteers.Guetter et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):W19http://www.jcmr-online.com/content/14/S1/W19Page 2 of 3Author details1Siemens Corporation, Corporate Research, Princeton, NJ, USA. 2Dorothy M.Davis Heart and Lung Research Institute, The Ohio State University,Columbus, OH, USA. 3Cleveland Clinic Foundation, Cleveland, OH, USA.Published: 1 February 2012References1. Weale , Guetter , et al: JCMR. 2011.2. Lu , Georgescu , et al: MICCAI. 2010.3. Guetter , Chefd’Hotel , et al: ISBI. 2011.doi:10.1186/1532-429X-14-S1-W19Cite this article as: Guetter et al.: Mitral valve annular velocitymeasurements derived from cine MRI: validation against Dopplerechocardiography. Journal of Cardiovascular Magnetic Resonance 2012 14(Suppl 1):W19.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitGuetter et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):W19http://www.jcmr-online.com/content/14/S1/W19Page 3 of 3

doi:10.1186/1532-429X-14-S1-W19 Cite this article as: Guetter et al.: Mitral valve annular velocity measurements derived from cine MRI: validation against Doppler echocardiography.

Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance

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Mitral valve annular velocity measurements derived from cine MRI: validation against Doppler echocardiography

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