The value of CMRI in hemodynamic quantification and functional interpretation of congenital, valvular, and cardiomyopathy diseases

Obtaining a comprehensive information about the heart and circulation function, hemodynamic parameters (volume, pressure, flow, resistance), and general principles and factors governing them is the critical part of physiology and pathophysiological cardiovascular evaluation of all patients suffering from heart disease. Their effects on diagnosis, clinical judgment and integrate decision making, medical and surgical measures, and prognosis are remarkable. Although classical hemodynamic monitoring is based on the invasive measurement, over the past decade, Cardiac MRI (CMRI) has been known as an accurate, reproducible, versatile, reliability, and new gold standard imaging modality in compare with other modalities (Echo, SPECT, PET) for achieving these goals. What CMRI provides, could be categorized as:A) LV and RV functions through: 1) Geometry, wall thickness, wall motion, mass, systolic and diastolic dimeters and Volume indexed to body size, SV, SVI, CO, CI, FS and EF. 2) Dynamic heart volume variation by volume–time curve analysis throughout the cardiac cycle ; ejection time, Peak ejection Rate, Peak filling rate, rapid filling time, diastasis time and volume, end-diastolic time and volume.3) Diastolic function through MV, TV, and SVC flow curves by phase contrast sequences in Patients with CHF, VHD, CAD, HCM, RCM, pericardial diseases, B) Pulmonary artery (PA) flow curve in patients with PV diseases, CHD, PAH, 1) PA acceleration time, PA pressure, forward flow volume, PR flow volume, PR fraction, C) Aortic artery (AO) flow curve in patients with AO.V diseases, CO. AO, CHD, CHF, CM.1) Flow onset, peak acceleration, peak flow, peak deceleration, cessation of flow, time to peak Acceleration, rise time, time from peak flow to peak deceleration, fall time, duration of flow 2) Measuring AR volume, AR fraction, forward flow volume, and duration of Regurgitation. D) Wall motion, strain, and stress by myocardial tagging sequence in patients with HCM, mass, Athlete heart, E) Quantification of flow dynamics of MV, TV, AOV, and PV flow curves in patients with Valvular heart diseases and calculation MR and TR flow volumes and their regurgitation Fraction, calculation of shuntF) Measurement of Coronary Blood Flow.G) First-pass myocardial perfusion study at rest and stress for: 1) Evaluation myocardial blood flow at rest and stress in patients with CAD and non- Ischemic cardiomyopathies. 2) Identifying Coronary microvascular disease with diffuse myocardial fibrosis.All hemodynamic parameters will be presented and discussed based on our patients CMR images. According to our experience, it could be suggested that CMRI has the capability to provide invaluable information of heart function and its hemodynamic parameters. Therefore, it could be substitute for catheterism and echocardiography.