Myocardial delayed enhancement in patients with pulmonary hypertension and right ventricular failure: evaluation by cardiac MRI

Abstract

In this study, we evaluated patients with pulmonary arterial hypertension (PAH) and impaired right ventricular function. We used cardiac MRI for the detection of myocardial delayed enhancement (MDE) and its possible association with other clinical variables. 20 patients (6 males and 14 females, aged 44.5+/-11 years; 15 New York Heart Association class III, 5 class IV) with known PAH (13 idiopathic, 7 resulting from chronic pulmonary embolism) were evaluated for the detection of MDE. Short-axis cine images of the heart were made for ventricular function assessment using a steady-state free precession sequence. For MDE evaluation, a short-axis phase-sensitive inversion recovery sequence was performed 10 min after intravenous administration of 0.2 mmol kg(-1) gadodiamide. Right ventricle (RV) systolic dysfunction, RV enlargement and RV hypertrophy were present in 20 patients (RV ejection fraction, 21.5+/-7.2%; RV diastolic diameter, 5.97+/-0.79 cm; RV wall thickness, 0.73+/-0.10 cm). 13 of the 20 patients (65%) were positive for MDE (10 anterior, 12 inferior). All 13 positive patients with MDE demonstrated small hyperintense areas at the insertion points of the RV free wall in the interventricular septum. We found no significant correlation between MDE and ejection fraction or other haemodynamic variables. In this study, MDE correlated positively only with the duration of disease. We found that septal MDE can be present in patients with PAH and impaired ventricular function. However, further studies are necessary to investigate this possible association and its prognostic implication.

Pulmonary Arterial Hypertension: Use of Delayed Contrast-Enhanced Cardiovascular Magnetic Resonance in Risk Assessment

“…Blyth et al 11 noticed the presence of DME on 23 of 25 study patients, of 3.3g and there was a positive correlation with several hemodynamic variables, primarily patients with paradoxical interventricular septum deviation. Junqueira et al 26 demonstrated the presence of DME in 65% of study patients and only found a positive correlation with the duration of the disease at diagnosis.…”

“…Even though there are several studies of DME evaluated by CMR in conditions that affect the LV, only three of major importance evaluated this finding in patients with PAH 11,25,26 .…”

Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension

“…However, unlike Blythe et al and Sanz et al, they did not find a significant correlation between the extent of LGE and hemodynamic parameters of PH, despite the fact that their cohort of patients had a higher overall mPAP when compared to the study by Blyth et al (54 ± 16 mmHg vs. 43 ± 12 mmHg) and Sanz et al (54 ± 16 mmHg vs. 44 ± 12). The most recent study examining RVIP-LGE in patients with PH showed RVIP-LGE in only 13/20 patients and the only significant correlation was found between the extent of LGE and the duration of disease and not with RV size, function, or hemodynamics [10]. Our study is in agreement with the findings by Blyth et al and Sanz et al but builds on the relatively small amount of data available on this topic by including more patients and additionally following them over time.…”

Cardiac magnetic resonance imaging in pulmonary arterial hypertension

“…A number of studies have also reported the presence of LGE in the right ventricular insertion point (RVIP) at the inter-ventricular septum (between the RV and LV) of patients with PAH. Results suggest a significant inverse correlation between the degree of RVIP-LGE and RVEF and haemodynamics [41][42][43][44]. Recently, RVIP-LGE has been shown to be associated with RV dilation and hypertrophy, reduced RVEF and more extensive haemodynamic abnormalities, as well as a univariate predictor of time to clinical worsening ( fig.…”