Abstract
ObjectivesTo analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics.MethodsFifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1.ResultsSeptal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249 ± 58 ms vs. 1186 ± 33 ms, p < 0.0001; lateral, 1190 ± 45 ms vs. 1150 ± 33 ms, p = 0.0003; global, 1220 ± 52 ms vs. 1171 ± 29 ms, p < 0.0001; VIP, 1298 ± 78 ms vs. 1193 ± 31 ms, p < 0.0001). In PH, LV eccentricity index was the strongest linear predictor of VIP T1 (r = 0.72). Septal, lateral and global T1 showed strong correlations with VIP T1 (r = 0.81, r = 0.59 and r = 0.75, respectively).ConclusionsIn patients with PH, T1 times in VIPs and in the entire LV myocardium are elevated. LV eccentricity strongly correlates with VIP T1 time, which in turn is strongly associated with T1 time changes in the entire LV myocardium.Key Points• Native T1 mapping detects left ventricular myocardial alterations in pulmonary hypertension• In pulmonary hypertension, native T1 times at ventricular insertion points are increased• These T1 times correlate strongly with left ventricular eccentricity• In pulmonary hypertension, global and segmental myocardial T1 times are increased• Global, segmental and ventricular insertion point T1 times are strongly correlated
Highlights
Patients with pulmonary hypertension (PH) are at risk for progressive heart failure [1, 2]
left ventricular (LV) eccentricity strongly correlates with ventricular insertion point (VIP) T1 time, which in turn is strongly associated with T1 time changes in the entire LV myocardium
As late gadolinium enhancement (LGE) imaging detects focal myocardial lesions but cannot assess diffuse myocardial remodelling [7], it remains unclear whether myocardial alterations in PH are restricted to the VIPs and intraventricular septum (IVS), or if the global left ventricular (LV) myocardium is affected by chronic right heart pressure overload [8, 9]
Summary
Patients with pulmonary hypertension (PH) are at risk for progressive heart failure [1, 2]. The extent of late gadolinium enhancement at the ventricular insertion points (VIPs) and intraventricular septum (IVS) on cardiac magnetic resonance (CMR) imaging of these patients has been identified as a marker of progression and clinical worsening of disease [3,4,5,6]. As late gadolinium enhancement (LGE) imaging detects focal myocardial lesions but cannot assess diffuse myocardial remodelling [7], it remains unclear whether myocardial alterations in PH are restricted to the VIPs and IVS, or if the global left ventricular (LV) myocardium is affected by chronic right heart pressure overload [8, 9]. Increasing with myocardial collagen content, myocardial T1 times have the potential to identify both focal and diffuse myocardial fibrosis on global as well as regional levels [11,12,13]. We hypothesized that in patients with PH, T1 maps could depict myocardial alterations at the VIPs and IVS and, if present, in the entire LV myocardium
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