Does late gadolinium enhancement still have value for the RV? RV internal mechanical work, Ea/Emax (VVC) and LGE as prognostic markers in pulmonary hypertension; a CMR study

Abouelnour, Amr; Doyle, Mark; Thompson, Diane V; Yamrozik, June; Williams, Ronald; Shah, Moneal; Soma, Siva; Murali, Srinivas; Benza, Raymond L.; Biederman, Robert W

doi:10.1186/1532-429x-18-s1-o136

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…95 Although previous studies have found associations between the presence of LGE and outcomes in cardiomyopathies, the predictive value in PH is less well established. [96][97][98] As with T1 and ECV, elevated LGE at the RV insertion point may also be related to mechanical stress rather than RV decompensation, and thus a marker of disease rather than disease severity.…”

Section: Tissue Characterization and Perfusion Imagingmentioning

confidence: 99%

Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart

Alenezi

Covington

Mukherjee³

et al. 2022

Circulation Research

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There is an increased appreciation for the importance of the right heart and pulmonary circulation in several disease states across the spectrum of pulmonary hypertension and left heart failure. However, assessment of the structure and function of the right heart and pulmonary circulation can be challenging, due to the complex geometry of the right ventricle, comorbid pulmonary airways and parenchymal disease, and the overlap of hemodynamic abnormalities with left heart failure. Several new and evolving imaging modalities interrogate the right heart and pulmonary circulation with greater diagnostic precision. Echocardiographic approaches such as speckle-tracking and 3-dimensional imaging provide detailed assessments of regional systolic and diastolic function and volumetric assessments. Magnetic resonance approaches can provide high-resolution views of cardiac structure/function, tissue characterization, and perfusion through the pulmonary vasculature. Molecular imaging with positron emission tomography allows an assessment of specific pathobiologically relevant targets in the right heart and pulmonary circulation. Machine learning analysis of high-resolution computed tomographic lung scans permits quantitative morphometry of the lung circulation without intravenous contrast. Inhaled magnetic resonance imaging probes, such as hyperpolarized 129Xe magnetic resonance imaging, report on pulmonary gas exchange and pulmonary capillary hemodynamics. These approaches provide important information on right ventricular structure and function along with perfusion through the pulmonary circulation. At this time, the majority of these developing technologies have yet to be clinically validated, with few studies demonstrating the utility of these imaging biomarkers for diagnosis or monitoring disease. These technologies hold promise for earlier diagnosis and noninvasive monitoring of right heart failure and pulmonary hypertension that will aid in preclinical studies, enhance patient selection and provide surrogate end points in clinical trials, and ultimately improve bedside care.

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Section: Tissue Characterization and Perfusion Imagingmentioning

confidence: 99%

Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart

Alenezi

Covington

Mukherjee³

et al. 2022

Circulation Research

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“…A total of 90% American patients with sarcoidosis have pulmonary involvement with a notable subset of these pulmonary sarcoidosis patients having pulmonary hypertension and elevated right ventricular (RV) filling pressures. Chronic pulmonary hypertension and elevated RV filling pressures can lead to increased cardiomechanical stress at the location where the RV myocardium inserts into the LV myocardium at the LV anteroseptal and inferoseptal walls leading to epicardial and midmyocardial myocardial fibrosis of the LV myocardium [27][28][29]. Thus, the pattern of RV insertion site LGE in a sarcoidosis patient frequently does not result from direct sarcoidosis myocardial disease of that region of the LV myocardium.…”

Section: Solitary Right Ventricular Insertion Site Late Gadolinium En...mentioning

confidence: 99%

Detection of early phenotype cardiac sarcoidosis by cardiovascular magnetic resonance

Levin

Baughman

Sweiss

2021

Current Opinion in Pulmonary Medicine

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Purpose of reviewCardiac sarcoidosis has high prevalence in sarcoidosis patients and contributes to significant morbidity and mortality. Early detection of cardiac sarcoidosis is essential to improving patients’ symptoms and cardiovascular outcomes.Recent findingsCardiovascular magnetic resonance imaging (CMR) is an excellent diagnostic modality for cardiac sarcoidosis. However, early phenotypes of cardiac sarcoidosis have more mild imaging phenotypes. These mild and sometimes subtle imaging phenotypes of cardiac sarcoidosis have lower diagnostic sensitivity and specificity for cardiac sarcoidosis by CMR when compared with more severe imaging phenotypes of cardiac sarcoidosis. In addition, many sarcoidosis patient cohorts frequently have heterogenous potential alternative etiologies for mild myocardial disease detected by mild late gadolinium enhancement (LGE) findings. In early phenotype cardiac sarcoidosis, analysis of the LGE pattern and location can improve the diagnostic specificity of these mild LGE findings.SummaryThe current review focuses on the current strengths and challenges in CMR detection of early phenotypes of cardiac sarcoidosis by the LGE technique.

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“…Cardiac magnetic resonance (CMR) allows for noninvasive assessment of myocardial edema, brosis or in ltration [1,2]. Simple presence of late gadolinium enhancement (LGE) in myocardial walls has been found in majority of patients with cardiac diseases and is often identi ed as brotic area [3,4]. LGE analysis is thus helpful to distinguish nonischemic dilated cardiomyopathy from advanced ischemic heart disease or in assessing functional recovery after revascularization procedures [5,6].…”

Section: Introductionmentioning

confidence: 99%

What is the meaning of LGE in right ventricle insertion points in pulmonary arterial hypertension? – a PET/MRI study

Kazimierczyk,

Szumowski,

Nekolla

et al. 2023

Preprint

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Presence of late gadolinium enhancement (LGE) in right ventricle insertion points (RVIPs) has been found in majority of pulmonary arterial hypertension (PAH) patients and is often recognized as evidence of myocardial fibrosis. The aim of the study was to evaluate the relationship between LGE mass and myocardium metabolic activity in RVIPs using PET/MRI imaging. Twenty-eight clinically stable PAH patients had PET/MRI scans during baseline and 2-year follow up (FU) visits. Fluorodeoxyglucose cardiac uptake was assessed in the area of LGE (SUVRVIPS). Clinical end-point (CEP) was defined as death or clinical deterioration. Mean LGE mass in RVIPs was 6.67±4.41 g and mean SUVRVIPS was 7.28±5.36. FU values were 8.01±7.75 g (p=0.27) and 5.81±3.16 (p=0.16), respectively. Decrease of SUVRVIPS was observed in 70% (n=14) cases. No statistically significant correlation was found between LGE mass and SUVRVIPS (in both baseline and FU scans). PAH therapy have an impact on both LGE mass and FDG uptake in cardiac local tissue changes. Lack of reverse correlation between those two parameters suggests that LGE is not less metabolically active than the surrounding myocardium and hence it is unlikely to be simple fibrotic change, however this finding requires further studies. Trial Registration: Clinical Trials.gov; NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689l https://clinicaltrials.gov/ct2/show/NCT03688698

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Does late gadolinium enhancement still have value for the RV? RV internal mechanical work, Ea/Emax (VVC) and LGE as prognostic markers in pulmonary hypertension; a CMR study

Cited by 4 publications

References 23 publications

Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart

Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart

Detection of early phenotype cardiac sarcoidosis by cardiovascular magnetic resonance

What is the meaning of LGE in right ventricle insertion points in pulmonary arterial hypertension? – a PET/MRI study

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