Regional and Global Biventricular Function in Pulmonary Arterial Hypertension: A Cardiac MR Imaging Study

Shehata, Monda L.; Harouni, Ahmed A.; Skrok, Jan; Basha, Tamer; Boyce, Danielle; Lechtzin, Noah; Mathai, Stephen C.; Girgis, Reda E.; Osman, Nael F.; Lima, João A.C.; Bluemke, David A.; Hassoun, Paul M.; Vogel‐Claussen, Jens

doi:10.1148/radiol.12111599

Cited by 67 publications

(58 citation statements)

References 25 publications

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“…84 Furthermore, it has been found that regional longitudinal wall deformation can already be disturbed at the time that global RV function is still intact, implying that changes in regional measures could be sensitive parameters to detect early RV dysfunction in PAH. 85 Insight into the global structure of the RV myocardium by MRI can be obtained by delayed contrast enhancement imaging with gadolinium or by T1 image mapping. With the use of gadolinium contrast, it was found that delayed contrast enhancement appeared at the interventricular insertion points and might be a reflection of focal fibrosis.…”

Section: Rv Function and Myocardiummentioning

confidence: 99%

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

et al. 2015

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899N oninvasive imaging plays a key role in both the diagnosis and management of patients with pulmonary hypertension (PH). In recent years, there have been 2 major changes in perspective of imaging in PH. The first was the realization that imaging should focus on the evaluation of not only the pulmonary pressures but also the cardiopulmonary unit ( Figure 1). 1,2The second was the emergence of multimodality imaging with a complementary role for echocardiography, magnetic resonance (MRI), computed tomography, and positron emission tomography (PET).2-7 These techniques not only help in the diagnosis of PH but also help identify factors that determine risk and prognosis and gauge therapeutic effects on right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart. 2-7 PET is also offering novel insights into perfusion and blood flow, metabolism, neurohormonal activation, and other molecular processes in the right side of the heart but is used mainly for research at this time. Catheterization of the right side of the heart remains the gold standard for defining PH and assessing hemodynamics both at rest and with exercise. Invasive assessment of cardiac output (CO) may, however, have limited accuracy when assumed instead of measured oxygen consumption is used to derive CO (eg, using the Fick method) or when thermodilution is used in the setting of a low-CO state. [8][9][10] This review covers RV imaging studies performed in the field of PH and discusses recent advances in echocardiography and cardiac MRI and PET imaging for detailed assessment of RV function. The review starts with a discussion of important physiological considerations and unmet needs in imaging research of the right side of the heart in PH. Computed tomography angiography, which plays an important role in evaluating chronic thromboembolic PH, is not discussed extensively in this review. Physiological ConsiderationsAlthough PH is a syndrome affecting the pulmonary vasculature, survival of patients with PH is closely related to RV function. 1,[11][12][13][14] The RV initially adapts to the increased afterload by increasing its wall thickness and contractility. These mechanisms are, however, often insufficient, and RV dysfunction eventually occurs. After the recent Fifth World Symposium on Pulmonary Hypertension, a definition of failure of the right side of the heart secondary to PH was adopted: "Right heart failure in the setting of PH can be defined as a complex clinical syndrome due to a suboptimal delivery of blood or elevated systemic venous pressure at rest or exercise as a consequence of elevated RV afterload."2 The proposed definition takes into account both the systolic and diastolic characteristics of function of the right side of the heart, as well as physiological demands such as exercise.In underst...

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Section: Rv Function and Myocardiummentioning

confidence: 99%

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

et al. 2015

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“…The RV and left ventricle (LV) share the interventricular septum (IVS) and are contained within the same pericardial sac, which leads to interventricular dependence; thus, RV pressure and volume loads cause leftward septal bowing, resulting in altered LV filling dynamics and function [4]. Recently, it has been reported that reduced biventricular regional function is associated with increased RV afterload [5,6]. Thus, biventricular assessment and follow-up in PH patients are critical.…”

Section: Introductionmentioning

confidence: 99%

Comparison of strain measurement from multimodality tissue tracking with strain-encoding MRI and harmonic phase MRI in pulmonary hypertension

Ohyama

Ambale-Venkatesh

Chamera

et al. 2015

International Journal of Cardiology

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“…Several studies have shown significant correlations between CMR-derived parameters and RHC-derived values of systolic and mPAP values. [10][11][12][13][14][15][16][17][18] However, controversies on their overall applicability and accuracy remain. Abolmaali et al, 19 in an experimental setting of acute PH and simultaneous invasive pressure recordings, demonstrated that mPAP can be estimated using velocity-encoded phase-contrast MRI (PC-MRI).…”

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Noninvasive Assessment of Pulmonary Hemodynamics in Patients With Chronic Thromboembolic Pulmonary Hypertension by High Temporal Resolution Phase-Contrast MRI

Kreitner

Wirth

Krummenauer

et al. 2013

Circ: Cardiovascular Imaging

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Noninvasive imaging modalities, such as echocardiography and MRI, have been used to predict pulmonary hypertension Background-Right heart catheterization is the gold standard for assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension. To date, MRI has not been able to produce precise measurements of mean pulmonary arterial pressure (mPAP). The purpose of the study was to create a model for estimating mPAP and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension by high temporal resolution phase-contrast MRI (PC-MRI) and to correlate the results with simultaneously acquired, invasive catheterbased measurements (simultaneously measured mPAP) and with right heart catheterization measurements. Methods and Results-A total of 19 patients with chronic thromboembolic pulmonary hypertension underwent right heart catheterization 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 (

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Regional and Global Biventricular Function in Pulmonary Arterial Hypertension: A Cardiac MR Imaging Study

Cited by 67 publications

References 25 publications

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Comparison of strain measurement from multimodality tissue tracking with strain-encoding MRI and harmonic phase MRI in pulmonary hypertension

Noninvasive Assessment of Pulmonary Hemodynamics in Patients With Chronic Thromboembolic Pulmonary Hypertension by High Temporal Resolution Phase-Contrast MRI

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