Pulmonary Hypertension: Accuracy of Detection with Left Ventricular Septal-to–Free Wall Curvature Ratio Measured at Cardiac MR

Abstract

In patients clinically known to have or suspected of having PH, cardiac MR-derived curvature ratio, as compared with RHC measurement, was an accurate and reproducible index for estimation of RVSP.

Late-onset pulmonary arterial hypertension after successful early arterial switch surgery for simple transposition of the great arteries

“…(9) (Figure 3) Cardiovascular magnetic resonance has the potential to overcome the anatomical limitations of imaging windows with transthoracic echocardiography in obese patients, or those with respiratory disease or chest wall deformities. (21,27) The extent of the left ventricular end-systolic geometric distortion is related to the increase in end-systolic right ventricular pressure, which results in a left-sided shift of the inter-ventricular septum. The degree of distortion can be expressed as the ratio of the end-systolic inter-ventricular septal and end-systolic left ventricular free wall curvature at basal left ventricular level.…”

“…The degree of distortion can be expressed as the ratio of the end-systolic inter-ventricular septal and end-systolic left ventricular free wall curvature at basal left ventricular level. (21) Both can be determined with either ultrasound or cardiovascular magnetic resonance. Figure 2b demonstrates how the endsystolic radius of both the end-systolic inter-ventricular septum and free wall can be determined by marking the anterior and inferior junctions between septum and free wall, and middle of septum and free wall.…”

“…Dellegrottaglie, et al demonstrated the left ventricular septal-to-free wall curvature ratio to be accurate and reproducible in 46 patients with pulmonary arterial hypertension (87% sensitivity, 100% specificity, mean difference -1.1mm Hg ±15.9 ). (21) Future studies employing ultrasound and magnetic resonance will determine the clinical relevance of this method.…”

“…(7)(8)(9) Late-onset pulmonary arterial hypertension after neonatal arterial switch surgery for simple d-transposition without remaining defects is however of right ventricular systolic pressures with magnetic resonance using the left ventricular septal-to-free wall curvature ratio according to Dellegrottaglie, et al estimated this to be 108mmHg (Figure 2b). (21) Sildenafil was the only effective agent available in South Africa to treat this condition. There was a delay in providing this drug to our patient due to difficulties in medical scheme funding.…”

Diagnosis and Management of Pulmonary Arterial Hypertension using MR Imaging

“…Several methods have been proposed to assess this septal curvature. Dellegrottaglie and associates 10 reported the accuracy and reproducibility of the curvature ratio of the LV septum to the free wall in predicting RV systolic pressure in patients clinically known to have or suspected of having PAH, with same-day right heart catheterization as the reference standard. Roeleveld and colleagues 11 reported that systolic pulmonary artery pressure (PAP) was proportional to septal curvature, with a regression coe‹cient (r) of 0.77 (Pº0.001), and demonstrated reduced leftward ventricular septal bowing after treatment with a vasodilator (epoprostenol).…”