Abstract
BackgroundThis study investigated the major clinical determinants of late gadolinium enhancement (LGE) at ventricular insertion points (VIPs) commonly seen in patients with pulmonary hypertension (PH).MethodsForty-six consecutive PH patients (mean pulmonary artery pressure ≥25 mmHg at rest) and 21 matched controls were examined. Right ventricular (RV) morphology, function and LGE mass volume at VIPs were assessed by cardiac magnetic resonance (CMR). Radial motion of the left ventricular (LV) wall and interventricular septum (IVS) was assessed by speckle-tracking echocardiography. Paradoxical IVS motion index was then calculated. Univariate and multivariate regression analysis were conducted to characterize the relationship between LGE volume at VIPs and PH-related clinical indices, including the paradoxical IVS motion index.ResultsMean pulmonary arterial pressure (MPAP) of PH patients was 38±9 mmHg. LGE at VIPs was observed in 42 of 46 PH patients, and the LGE volume was 2.02 mL (0.47–2.99 mL). Significant correlations with LGE volume at VIPs were observed for MPAP (r = 0.50) and CMR-derived parameters [RV mass index (r = 0.53), RV end-diastolic volume index (r = 0.53), RV ejection fraction (r = −0.56), and paradoxical IVS motion index (r = 0.77)]. In multiple regression analysis, paradoxical IVS motion index alone significantly predicted LGE volume at VIPs (p<0.001).ConclusionsLGE at VIPs seen in patients with PH appears to reflect altered IVS motion rather than elevated RV pressure or remodeling. Long-term studies would be of benefit to characterize the clinical relevance of LGE at VIPs.
Highlights
Pulmonary hypertension (PH) is defined as mean pulmonary arterial pressure (PAP) $25 mmHg at rest. [1] If untreated, the vasculopathy often progresses and leads to right ventricular (RV) failure and premature death
When comparing the 46 pulmonary hypertension (PH) patients and the 21 control subjects, no significant demographic differences were apparent including in body mass index, smoking history and the prevalence of cardiovascular/ respiratory diseases
Cardiac magnetic resonance (CMR) Measurements in Controls and PH Patients CMR images were acquired from all participants, and the image quality was sufficient for the subsequent analysis
Summary
Pulmonary hypertension (PH) is defined as mean pulmonary arterial pressure (PAP) $25 mmHg at rest. [1] If untreated, the vasculopathy often progresses and leads to right ventricular (RV) failure and premature death. CMR studies of PH have described increased size and impaired function of the right ventricle. [2] Recent CMR studies have demonstrated late gadolinium enhancement (LGE) at ventricular insertion points (VIPs). Previous studies have shown significant associations between LGE volume at VIPs and measurements of pulmonary hemodynamics and RV morphology. [13] This paradoxical IVS movement has been described in PH[14,15,16] and, it can be assumed that altered IVS motion might be the predominant mechanism of LGE at IVS rather than increased RV pressure and/or remodeling. This study investigated the major clinical determinants of late gadolinium enhancement (LGE) at ventricular insertion points (VIPs) commonly seen in patients with pulmonary hypertension (PH)
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