Cardiovascular magnetic resonance-derived left ventricular intraventricular pressure gradients among patients with precapillary pulmonary hypertension

Abstract

Aims Precapillary pulmonary hypertension (pPH) affects left ventricular (LV) function by ventricular interdependence. Since LV ejection fraction (EF) is commonly preserved, LV dysfunction should be assessed with more sensitive techniques. Left atrial (LA) strain and estimation of LV intraventricular pressure gradients (IVPG) may be valuable in detecting subtle changes in LV mechanics; however, the value of these techniques in pPH is unknown. Therefore, the aim of our study is to evaluate LA strain and LV-IVPGs from cardiovascular magnetic resonance (CMR) cines in pPH patients. Methods and results In this cross-sectional study, 31 pPH patients and 22 healthy volunteers underwent CMR imaging. Feature-tracking LA strain was measured on four- and two-chamber cines. LV-IVPGs (from apex–base) are computed from a formulation using the myocardial movement and velocity of the reconstructed 3D-LV (derived from long-axis cines using feature-tracking). Systolic function, both LV EF and systolic ejection IVPG, was preserved in pPH patients. Compared to healthy volunteers, diastolic function was impaired in pPH patients, depicted by (i) lower LA reservoir (36 ± 7% vs. 26 ± 9%, P < 0.001) and conduit strain (26 ± 6% vs. 15 ± 8%, P < 0.001) and (ii) impaired diastolic suction (−9.1 ± 3.0 vs. ‒6.4 ± 4.4, P = 0.02) and E-wave decelerative IVPG (8.9 ± 2.6 vs. 5.7 ± 3.1, P < 0.001). Additionally, 11 pPH patients (35%) showed reversal of IVPG at systolic–diastolic transition compared to none of the healthy volunteers (P = 0.002). Conclusions pPH impacts LV function by altering diastolic function, demonstrated by an impairment of LA phasic function and LV-IVPG analysis. These parameters could therefore potentially be used as early markers for LV functional decline in pPH patients.

CMR-derived left ventricular intraventricular pressure gradients identify different patterns associated with prognosis in dilated cardiomyopathy

“…In addition, inter- and intra-observer variability is very limited. 13 In our study, LV-IVPG analysis revealed different patterns in DCM patients, and several parameters were predictive of adverse outcome, independent of known clinical and imaging predictors such as LGE, LA strain, and LV-GLS which have been extensively investigated as important prognostic markers in DCM as well. 26–28 Therefore, this analysis could potentially improve risk stratification and clinical management.…”

“… 9 , 22 The association of higher RVEDVi with the IVPG reversal pattern might be explained by ventricular interdependence as is seen in a previous pulmonary hypertension study of ours. 13 Ventricular conduction delay (QRS > 120 ms), indicating dyssynchrony, was associated with an IVPG shift as well. Dyssynchrony is known to influence LV-IVPGs, as is described in a HF study in which the presence of a LBBB altered LV-IVPGs to a more orthogonal direction in early diastole.…”

“…The IVPG-time curve represents the IVPG directed from apex to base throughout the cardiac cycle. The overall LV-IVPG (throughout the whole cardiac cycle), A-, B-, C-, and D-waves evaluated in this study are illustrated in Figure 1 and in the tutorial video of the IVPG analysis in the Supplementary Material (see Supplementary data online , Video S1 , modified from Vos et al 13 ). All CMR analyses were performed by two trained independent investigators (J.V.…”

Abnormal Diastolic Hemodynamic Forces: A Link Between Right Ventricular Wall Motion, Intracardiac Flow, and Pulmonary Regurgitation in Repaired Tetralogy of Fallot

“…Previous studies have shown that HDF represents a sensible indicator of ventricular function that may show early alterations of ventricular function ( 11 ). HDF analysis can differentiate heart failure patients with preserved ejection fraction compared to controls with similar ejection fraction ( 11 ), reveal subclinical dysfunction due to cardiotoxicity from anthracycline chemotherapy ( 30 ), and it was the first left ventricular parameter to testify the impact of precapillary pulmonary hypertension on cardiac function ( 31 ). As HDF drives the intraventricular pressure gradient exchanged within the myocardium, stimulation of mechanoreceptors may provoke activation of intracellular pathways involved in cardiac adaptation and remodeling ( 32 , 33 ).…”

Reliability of left ventricular hemodynamic forces derived from feature-tracking cardiac magnetic resonance.

“…More recently, the study by Vos et al [21] used the same approach as our study in patients with pulmonary hypertension; however, they looked into different parameters, according to the different cardiac phases (systolic ejection, systo-diastolic transition, and the passive and active lling), while we considered HDF throughout the entire cardiac cycle.…”