Evaluation of Cor Pulmonale on a Modified Short-axis Section of the Heart by Magnetic Resonance Imaging

Saito, Hiroyuki; Dambara, Takashi; Aiba, Miyoji; Suzuki, Tsutomu; Kira, Shiro

doi:10.1164/ajrccm/146.6.1576

Cited by 39 publications

(13 citation statements)

References 10 publications

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“…In other words, thickening of the RV wall is caused by RV pressure overload, as in the left ventricle. Saito et al [23] demonstrated that there were significant correlations between RV wall thickness evalu ated by magnetic resonance imaging (MRI) and PAm or total pulmonary resistance or pulmonary arteriolar resis tance. Although we did not perform thallium myocardial scintigraphy and MRI, and pulmonary hypertension was generally mild to modest in our cases, the following was speculated: RV hypertrophy according to the degree of pressure overload exists in our CPD and PTE patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Right Ventricular Diastolic Function by Pulsed Doppler Echocardiography in Chronic Pulmonary Disease and Pulmonary Thromboembolism

Nakamura

Miyahara²,

Ikeda³

et al. 1995

Respiration

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We evaluated right ventricular (RV) diastolic performance in 12 healthy subjects (control), 25 patients with chronic pulmonary diseases (CPD) and 6 patients with chronic pulmonary thromboembolism (PTE). Flow velocity patterns were determined by the pulsed Doppler technique. The values determined included acceleration time (AT), deceleration time (DT), and the ratio of the atrial contraction wave (A) to the rapid filling wave (R) (A/R ratio) from flow velocity patterns in the RV inflow tract. DT was significantly prolonged in the CPD and PTE groups compared with the control group, indicating dysfunction during the early (middle) filling period. The prolongation was marked in those patients with pulmonary hypertension. The A/R ratio was significantly higher in the CPD and PTE groups than in the control group, indicating a decrease in RV compliance. The A/R ratio increased slightly with the increase in the end-diastolic volume index. These results suggested that the pressure overload plays an important role in RV diastolic dysfunction in patients with pulmonary disease, and that preload contributes to the dysfunction.

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Section: Discussionmentioning

confidence: 99%

Assessment of Right Ventricular Diastolic Function by Pulsed Doppler Echocardiography in Chronic Pulmonary Disease and Pulmonary Thromboembolism

Nakamura

Miyahara²,

Ikeda³

et al. 1995

Respiration

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“…Right ventricular end-diastolic wall thickness has been shown to correlate well with MPAP in primary pulmonary hypertension (PPH) and some causes of secondary pulmonary hypertension [17][18][19]. A linear relationship between RVM and MPAP has been described for PPH but not for other forms of PAHT [8].…”

mentioning

confidence: 99%

Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure

Saba¹,

Foster²,

Cockburn³

et al. 2002

Eur Respir J

168

116

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Magnetic resonance imaging (MRI) can provide accurate anatomical measurements of the cardiac ventricles. This study investigated whether a calculated ventricular mass index (VMI) would provide an accurate means of estimating pulmonary artery pressure noninvasively, and compared the results with conventional Doppler echocardiography and invasive measurement.A total of 26 subjects referred for investigation of pulmonary hypertension were studied by MRI and echocardiography within 2 weeks of cardiac catheterisation. The correlations for mean pulmonary artery pressure were as follows: VMI (ratio of right ventricular mass over left ventricular mass) r=0.81; pulmonary artery systolic pressure (echocardiography) r=0.77. The confidence intervals for the VMI were narrower than for echocardiography. Sensitivity and specificity for pulmonary hypertension were 84 and 71% respectively for the VMI compared with 89 and 57% for echocardiography.The calculated ventricular mass index provides an accurate and practical means of estimating pulmonary artery pressure noninvasively in pulmonary hypertension and may provide a more accurate estimate than Doppler echocardiography. This may be because it reflects the right ventricular response to sustained pulmonary hypertension over a long period and is not influenced by short-term physiological variables affecting echocardiography, such as heart rate, posture, hydration status and oxygen supplementation. Pulmonary arterial hypertension (PAHT) is a rare disorder characterised by high pulmonary vascular resistance. Prognosis is related to mean pulmonary artery pressure (MPAP) measured at right heart catheterisation (RHC) [1], and repeated measurements are often necessary to assess disease progression and the response to treatment. The most widely used noninvasive technique, Doppler echocardiography (ECHO) [2] is safe and widely available, but has several limitations. Firstly, it cannot measure MPAP and only provides an estimate of pulmonary artery systolic pressure (PASP). Secondly, it depends upon the presence of detectable tricuspid regurgitation and has a significant failure rate in some patient groups [3]. Finally, measurements are somewhat operatordependent, and influenced by physiological variables such as heart rate, hydration status and posture, limitations that also affect the accepted gold standard method of RHC [4].Magnetic resonance imaging (MRI) is an attractive modality for studying the complex geometry of the right ventricle and pulmonary vasculature since no assumptions need to be made about the shape or location of the structure being studied. It provides three-dimensional anatomical measurements of right ventricular morphology that are unaffected by physiological variables and more likely to be reproducible than dynamic, planar measurements made at ECHO. Furthermore, these anatomical variables assess the right ventricular response to chronic pulmonary vascular disease and may provide a more clinically relevant assessment of disease severity.MRI has been extensi...

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“…Several estimators based on different MRI techniques have been described in recent years, including acceleration time (the time of onset of forward flow to the moment of maximum flow velocity in the main pulmonary artery), acceleration time/ejection time ratio, pulse wave velocity, cross-sectional area of the main pulmonary artery and ventricular mass index. Right ventricular end-diastolic wall thickness has been shown to correlate well with mean Ppa in idiopathic pulmonary arterial hypertension and some cases of secondary pulmonary hypertension [58,59]. A linear relationship between right ventricle mass and mean Ppa has been described for idiopathic pulmonary arterial hypertension [13].…”

Section: Ppa Estimation By Cmrmentioning

confidence: 97%

Cardiac magnetic resonance imaging for the assessment of the heart and pulmonary circulation in pulmonary hypertension

McLure

Peacock²

2009

Eur Respir J

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Pulmonary hypertension is a disease of the pulmonary arteries resulting in a progressive increase in pulmonary vascular resistance, ultimately leading to right ventricular failure and death. The functional capacity of the right ventricle is a major prognostic determinant. Our understanding of right ventricle performance in pulmonary hypertension has been hindered by the lack of techniques that give a reliable picture of right ventricle morphology and function. Cardiac magnetic resonance (CMR) imaging enables a unique combination of morphological and functional assessment of the right ventricle and pulmonary circulation. In this review article, we introduce the technique of CMR imaging, review its use in imaging of the heart and pulmonary circulation and discuss its current and future application to the management of patients with pulmonary hypertension.There have been recent major advances in our understanding of the mechanism of disease development, in the diagnostic process, and in the treatment of pulmonary hypertension. Therapeutic advances in the management have reinforced the requirement for noninvasive, accurate and reproducible methods of assessment to act as ''end-points'' to measure the effects of treatment. We anticipate CMR imaging will increasingly be utilised as the primary modality for combined anatomic and functional assessments that enable more complete and efficient evaluation of pulmonary hypertension patients.

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Evaluation of Cor Pulmonale on a Modified Short-axis Section of the Heart by Magnetic Resonance Imaging

Cited by 39 publications

References 10 publications

Assessment of Right Ventricular Diastolic Function by Pulsed Doppler Echocardiography in Chronic Pulmonary Disease and Pulmonary Thromboembolism

Assessment of Right Ventricular Diastolic Function by Pulsed Doppler Echocardiography in Chronic Pulmonary Disease and Pulmonary Thromboembolism

Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure

Cardiac magnetic resonance imaging for the assessment of the heart and pulmonary circulation in pulmonary hypertension

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