Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertension

Abstract

Background Right ventricular function is an important prognostic marker for pulmonary arterial hypertension. Native T1 mapping using cardiovascular magnetic resonance imaging can characterize the myocardium, but accumulating evidence indicates that T1 values of the septum or ventricular insertion points do not have predictive potential in pulmonary arterial hypertension. We aimed to elucidate whether native T1 values of the right ventricular free wall (RVT1) can predict poor outcomes in patients with pulmonary arterial hypertension. Methods This retrospective study included 30 patients with pulmonary arterial hypertension (median age, 45 years; mean pulmonary artery pressure, 41±13 mmHg) and 16 healthy controls (median age, 43 years) who underwent native T1 mapping. RVT1 was obtained from the inferior right ventricular free wall during end systole. Results Patients with pulmonary arterial hypertension had significantly higher native RVT1 than did controls (1384±74 vs. 1217±57 ms, p<0.001). Compared with T1 values of the septum or ventricular insertion points, RVT1 correlated better with the effective right ventricular elastance index (R = −0.53, p = 0.003), ventricular-arterial uncoupling (R = 0.46, p = 0.013), and serum brain natriuretic peptide levels (R = 0.65, p<0.001). Moreover, the baseline RVT1 was an accurate predictor of the reduced right ventricular ejection fraction at the 12-month follow-up (delta -3%). RVT1 was independently associated with composite events of death or hospitalization from any cause (hazard ratio = 1.02, p = 0.002). Conclusions RVT1 was predictive of right ventricular performance and outcomes in patients with pulmonary arterial hypertension. Thus, native T1 mapping in the right ventricular free wall may be an effective prognostic method for pulmonary arterial hypertension.

Right ventricular fibrosis in adults with uncorrected secundum atrial septal defect and pulmonary hypertension: a cardiovascular magnetic resonance study with late gadolinium enhancement, native T1 and extracellular volume

“…Native T1 and ECV in our study correlated well with RV hemodynamics and function, particularly at RVIP and septal regions. These findings are in good agreement with previous studies on the PH population, which found a moderate to strong correlation between native T1 at the insertion point and septal region with mPAP, PVR, and RV ejection fraction ( 43 – 46 ). Global RV and septal ECV were also shown to correlate to mPAP and RV function ( 21 , 47 ).…”

3D whole heart k-space-based super-resolution cardiac T1 mapping using rotated stacks

“…Cardiac T1 mapping provides valuable quantitative information for the diagnosis of a variety of heart diseases (Schelbert and Messroghli 2016, Haaf et al 2017, Al-Wakeel-Marquard et al 2021. While in clinical routine diagnostics are more focused on the left ventricle, quantitative imaging of the right ventricular wall (Asano et al 2021) or the atrial wall (Beinart et al 2013) is also of high diagnostic value. Isotropic high-resolution whole-heart coverage would strongly improve diagnostic information about fibrosis in atrial walls in arrhythmic patients (Beinart et al 2013) and improve diagnostic capability in patients with pulmonary arterial hypertension (Asano et al 2021).…”

“…While in clinical routine diagnostics are more focused on the left ventricle, quantitative imaging of the right ventricular wall (Asano et al 2021) or the atrial wall (Beinart et al 2013) is also of high diagnostic value. Isotropic high-resolution whole-heart coverage would strongly improve diagnostic information about fibrosis in atrial walls in arrhythmic patients (Beinart et al 2013) and improve diagnostic capability in patients with pulmonary arterial hypertension (Asano et al 2021). As these structures are usually very thin (Whitaker et al 2016) (between 1 and 4 mm) and complexly curved, high spatial resolution is needed.…”

Value of Right and Left Ventricular T1 and T2 Blood Pool Mapping in Patients with Chronic Thromboembolic Hypertension before and after Balloon Pulmonary Angioplasty

“…This has meanwhile favored, that parametric imaging is subject of multiple studies in patients with different etiologies of pulmonary hypertension (PH). So far, pathological elevations of cardiac native T1 time and extracellular volume (ECV) compared to healthy volunteers, promising correlations to functional and hemodynamic parameters and influences on patient outcome and survival have already been demonstrated [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Even more, parametric imaging seems to be suitable to investigate therapy effects—for example, of balloon pulmonary angioplasty (BPA)—on cardiac function and pulmonary hemodynamic in chronic thromboembolic pulmonary hypertension (CTEPH) [ 9 ].…”