Regional and Global Biventricular Function in Pulmonary Arterial Hypertension: A Cardiac MR Imaging Study
Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md.Radiology (Impact Factor: 6.87). 11/2012; 266(1). DOI: 10.1148/radiol.12111599
Purpose:To determine whether chronic pulmonary arterial pressure (PAP) elevation affects regional biventricular function and whether regional myocardial function may be reduced in pulmonary arterial hypertension (PAH) patients with preserved global right ventricular (RV) function.Materials and Methods:After informed consent, 35 PAH patients were evaluated with right heart catheterization and cardiac magnetic resonance (MR) imaging and compared with 13 healthy control subjects. Biventricular segmental, section, and mean ventricular peak systolic longitudinal strain (E(LL)), as well as left ventricular (LV) circumferential and RV tangential strains were compared between PAH patients and control subjects and correlated with global function and catheterization of the right heart indexes. Spearman ρ correlation with Bonferroni correction was used. Multiple linear regression analysis was performed to determine predictors for regional myocardial function.Results:In the RV of PAH patients, longitudinal contractility was reduced at the basal, mid, and apical levels, and tangential contractility was reduced at the midventricular level. Mean RV E(LL) positively correlated with mean PAP (r = 0.62, P < .0014) and pulmonary vascular resistance index (PVRI) (r = 0.77, P < .0014). Mean PAP was a predictor of mean RV E(LL) (β = .19, P = .005) in a multiple linear regression analysis. In the LV, reduced LV longitudinal and circumferential contractility were noted at the base. LV anteroseptal E(LL) positively correlated with increased mean PAP (r = 0.5, P = .03) and septal eccentricity index (r = 0.5, P = .01). In a subgroup of PAH patients with normal global RV function, significantly reduced RV longitudinal contractility was noted at basal and mid anterior septal insertions, as well as the mid anterior RV wall (P < .05 for all).Conclusion:In PAH patients, reduced biventricular regional function is associated with increased RV afterload (mean PAP and PVRI). Cardiac MR imaging helps identify regional RV dysfunction in PAH patients with normal global RV function.© RSNA, 2012Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111599/-/DC1.
- American Journal of Respiratory and Critical Care Medicine 07/2013; 188(1):23-8. DOI:10.1164/rccm.201303-0470UP · 13.00 Impact Factor
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ABSTRACT: -Right heart catheterization (RHC) is the gold standard for assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). So far, MRI has not been able to produce precise measurements of mPAP. The purpose of the study was to create a model for estimating mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with CTEPH by high temporal resolution phase-contrast MR imaging (PC-MRI) and to correlate the results with simultaneously acquired, invasive catheter-based measurements (mPAP_sim) and with RHC measurements. -19 patients with CTEPH underwent RHC and - after digital subtraction angiography of the pulmonary arteries - subsequent PC-MRI at 1.5 T with simultaneous recording of mPAP. Velocity- and flow-time curves of PC-MRI were used to calculate absolute acceleration time (Ata), maximum of mean velocities (MV), volume of acceleration (AV), and maximum flow acceleration (dQ/dt). Based on these parameters, multiple linear regression analysis revealed maximum achievable model fit (B = 0.902) for the following linear combination equation to calculate mPAP (mPAP_cal): mPAP_cal = 69.446 - (0.521 • Ata) - (0.570 • MV) + (1.507 • AV) + (0.002 • dQ/dt). There was a statistically significant equivalence of mPAP_cal and mPAP_sim with a goodness of fit of 0.892. PVR was overestimated by calculated PVR based on PC-MRI in comparison with RHC-based measurements by a median of -112 dyn•s•cm(-5), the pairwise regression formula revealed a goodness of fit of 0.792. -PC-MRI derived parameters enable non-invasive assessment of pulmonary hemodynamics in patients with CTEPH.Circulation Cardiovascular Imaging 07/2013; 6(5). DOI:10.1161/CIRCIMAGING.112.000276 · 5.32 Impact Factor
- Circulation Cardiovascular Imaging 09/2013; 6(5):609-11. DOI:10.1161/CIRCIMAGING.113.000936 · 5.32 Impact Factor
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