Heart Failure: Evaluation of Cardiopulmonary Transit Times with Time-resolved MR Angiography

PURPOSE: To measure cardiopulmonary transit times in patients with heart failure by using low-dose, time-resolved magnetic resonance (MR) angiography and to determine if transit curves reflect conventional MR indexes of cardiac function.

MATERIALS AND METHODS: Twenty-six patients with heart failure and left ventricular (LV) systolic dysfunction (17 men and nine women; age range, 22–78 years) and thirteen control subjects (eight men and five women; age range, 23–59 years) were examined with MR imaging. The examination consisted of rapid cine MR imaging throughout the heart, followed by contrast material–enhanced time-resolved three-dimensional MR angiography of the cardiac chambers and pulmonary vasculature. Time-intensity curves for the pulmonary artery and ascending aorta were derived from the MR angiography images. Cardiopulmonary transit times and dispersions (full widths at half maximum [FWHM]) were determined from the curves. Transit times and FWHM values for the patients with heart failure were compared with control values by using two-tailed t tests, and transit time was correlated with standard LV functional parameters calculated from the cine MR images.

RESULTS: Cardiopulmonary transit times and FWHM values were significantly prolonged in the patients with heart failure compared with those in the control patients (P < .001). Transit time correlated directly with LV end-diastolic and end-systolic volumes and inversely with LV ejection fraction (R > 0.60). However, transit time did not correlate strongly with age, body surface area, heart rate, LV mass, stroke volume, cardiac output, or sphericity index.

CONCLUSION: Time-resolved MR angiography allows determination of cardiopulmonary transit times that are significantly prolonged in heart failure and correlate directly with LV volumes and inversely with LV ejection fraction.

© RSNA, 2003

References

  • 1 Friedberg CK. Diseases of the heart 3rd ed. Philadelphia, Pa: Saunders, 1966. Google Scholar
  • 2 Morris LE, Blumgart HL. Velocity of blood flow in health and disease. Circulation 1957; 15:448-460. Crossref, MedlineGoogle Scholar
  • 3 Gargill SL. The use of sodium dehydrocholate as a clinical test of the velocity of blood flow. N Engl J Med 1933; 209:1089-1093. CrossrefGoogle Scholar
  • 4 Gernandt B, Nylin G. The relation between circulation time and the amount of the residual blood in the heart. Am Heart J 1946; 32:411-418. Crossref, MedlineGoogle Scholar
  • 5 Hitzig WM, King FH, Fishberg AM. Circulation time in failure of the left side of the heart. Arch Intern Med 1935; 55:112-120. CrossrefGoogle Scholar
  • 6 Meneely GR, Kaltreider NL. A study of the volume of the blood in congestive heart failure: relation to other measurements in fifteen patients. J Clin Invest 1943; 22:521-530. Crossref, MedlineGoogle Scholar
  • 7 Nathanson MH, Elek SR. The influence of heart size on the circulation time. Am Heart J 1947; 33:464-476. Crossref, MedlineGoogle Scholar
  • 8 Mahl MM, Lange K. Reliability of subjective circulation time determinations: a comparison between objective and subjective methods. Circulation 1958; 17:922-926. Crossref, MedlineGoogle Scholar
  • 9 Blumgart HL, Weiss S. Clinical studies on the velocity of blood flow. IX. The pulmonary circulation time, the velocity of venous blood flow to the heart, and related aspects of the circulation in patients with cardiovascular disease. J Clin Invest 1928; 5:343-377. Google Scholar
  • 10 Francois CJ, Bonow RO, Shors SM, Finn JP. Analysis of transit times in heart disease with contrast enhanced magnetic resonance imaging. Radiology 2003; 227:447-452. LinkGoogle Scholar
  • 11 Goldman JP, Cohen E, Rosenbluth A, Poon M. Contrast bolus MR transit time through the pulmonary circulation in pulmonary hypertension: a novel noninvasive index of pulmonary flow (abstr) In: Proceedings of the Tenth Meeting of the International Society for Magnetic Resonance in Medicine. Berkeley, Calif: International Society for Magnetic Resonance in Medicine, 2002. Google Scholar
  • 12 Jones RH, Sabiston DC, Jr, Bates BB, Morris JJ, Anderson PA, Goodrich JK. Quantitative radionuclide angiocardiography for determination of chamber to chamber cardiac transit times. Am J Cardiol 1972; 30:855-864. Crossref, MedlineGoogle Scholar
  • 13 Leitl GP, Buchanan JW, Wagner HN, Jr. Monitoring cardiac function with nuclear techniques. Am J Cardiol 1980; 46:1125-1132. Crossref, MedlineGoogle Scholar
  • 14 Muller HM, Tripolt MB, Rehak PH, Groell R, Rienmuller R, Tscheliessnigg KH. Noninvasive measurement of pulmonary vascular resistances by assessment of cardiac output and pulmonary transit time. Invest Radiol 2000; 35:727-731. Crossref, MedlineGoogle Scholar
  • 15 Shipley RA, Clark RE, Liebowitz D, Krohmer JS. Analysis of the radiocardiogram in heart failure. Circ Res 1953; 1:428-438. Crossref, MedlineGoogle Scholar
  • 16 Finn JP, Baskaran V, Carr JC, et al. Thorax: low-dose contrast-enhanced three-dimensional MR angiography with subsecond temporal resolution: initial results. Radiology 2002; 224:896-904. LinkGoogle Scholar
  • 17 Buser PT, Auffermann W, Holt WW, et al. Noninvasive evaluation of global left ventricular function with use of cine nuclear magnetic resonance. J Am Coll Cardiol 1989; 13:1294-1300. Crossref, MedlineGoogle Scholar
  • 18 Katz J, Milliken MC, Stray-Gundersen J, et al. Estimation of human myocardial mass with MR imaging. Radiology 1988; 169:495-498. LinkGoogle Scholar
  • 19 Matsumura K, Nakase E, Haiyama T, et al. Determination of cardiac ejection fraction and left ventricular volume: contrast-enhanced ultrafast cine MR imaging vs IV digital subtraction ventriculography. AJR Am J Roentgenol 1993; 160:979-985. Crossref, MedlineGoogle Scholar
  • 20 Semelka RC, Tomei E, Wagner S, et al. Normal left ventricular dimensions and function: interstudy reproducibility of measurements with cine MR imaging. Radiology 1990; 174:763-768. LinkGoogle Scholar
  • 21 Semelka RC, Tomei E, Wagner S, et al. Interstudy reproducibility of dimensional and functional measurements between cine magnetic resonance studies in the morphologically abnormal left ventricle. Am Heart J 1990; 119:1367-1373. Crossref, MedlineGoogle Scholar
  • 22 Carr JC, Simonetti O, Bundy J, Li D, Pereles S, Finn JP. Cine MR angiography of the heart with segmented true fast imaging with steady-state precession. Radiology 2001; 219:828-834. LinkGoogle Scholar
  • 23 Metz CE. Basic principles of ROC analysis. Semin Nucl Med 1978; 8:283-298. Crossref, MedlineGoogle Scholar
  • 24 Eichhorn EJ. Prognosis determination in heart failure. Am J Med 2001; 110(suppl 7A):14S-36S. CrossrefGoogle Scholar
  • 25 Peters AM. Fundamentals of tracer kinetics for radiologists. Br J Radiol 1998; 71:1116-1129. Crossref, MedlineGoogle Scholar
  • 26 Kim RJ, Fieno DS, Parrish TB, et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 1999; 100:1992-2002. Crossref, MedlineGoogle Scholar
  • 27 Shellock FG, Kanal E. Safety of magnetic resonance imaging contrast agents. J Magn Reson Imaging 1999; 10:477-484. Crossref, MedlineGoogle Scholar
  • 28 Klingensmith WC, III. Regional blood flow with first circulation time-indicator curves: a simplified, physiologic method of interpretation. Radiology 1983; 149:281-286. LinkGoogle Scholar
  • 29 Slutsky RA, Bhargava V, Higgins CB. Pulmonary circulation time: comparison of mean, median, peak, and onset (appearance) values using indocyanine green and first-transit radionuclide techniques. Am Heart J 1983; 106:41-45. Crossref, MedlineGoogle Scholar
  • 30 Slutsky RA, Carey PH, Bhargava V, Higgins CB. A comparison of peak-to-peak pulmonary transit time determined by digital intravenous angiography with standard dye-dilution techniques in anesthetized dogs. Invest Radiol 1982; 17:362-366. Crossref, MedlineGoogle Scholar
  • 31 Krinsky GA, Kaminer E, Lee VS, Rofsky NM, Weinreb JC. The effects of apnea on timing examinations for optimization of gadolinium-enhanced MRA of the thoracic aorta and arch vessels. J Comput Assist Tomogr 1998; 22:677-681. Crossref, MedlineGoogle Scholar

Article History

Published in print: Dec 2003