Prevalence and Correlates of Septal Delayed Contrast Enhancement in Patients With Pulmonary Hypertension†

Sanz, Javier; Dellegrottaglie, Santo; Kariisa, Mbabazi; Sulica, Roxana; Poon, Michael; O’Donnell, Thomas; Mehta, Davendra; Fuster, Valentín; Rajagopalan, Sanjay

doi:10.1016/j.amjcard.2007.03.094

Cited by 112 publications

(86 citation statements)

References 19 publications

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“…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. [86][87][88][89] The extent of delayed contrast enhancement was strongly correlated with increased RV mass, volumes, and pulmonary pressures (ie, RV wall stress). 88,90 However, despite being very sensitive to small areas of regional fibrosis, delayed contrast enhancement techniques are not able to depict more diffuse fibrosis because the technique depends on the comparison with normal reference areas of myocardium.…”

Section: Rv Function and Myocardiummentioning

confidence: 98%

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: 98%

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

et al. 2015

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“…71,98,99 Recently, magnetic resonance imaging delayed gadolinium enhancement, thought to represent fibrosis, at the RV septal insertion points has been found almost universally in adult patients with PAH and is in direct relation to the degree of RV afterload. 98,100,101 Fibrosis at the RV septal insertions was associated with reduced RV longitudinal contraction, 101 and the extent of RV fibrosis in PAH has been inversely related to RV ejection fraction, stroke volume, and end-systolic volume and to increased mortality. 98 The improvement seen in RV and LV function with the addition of a mild aortic band in our rabbit model may stem from amelioration of the septal shift induced by the aortic band, by improvement in ventricular geometry, and by inducing increased LV contractility through a modest increase in LV afterload.…”

Section: March 4 2014mentioning

confidence: 99%

Right Versus Left Ventricular Failure

2014

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1033V entricular failure manifests in many forms, its underlying physiology ranging from overt left ventricular (LV) systolic dysfunction to isolated right ventricular (RV) diastolic dysfunction, and the wide portfolio of resulting symptoms vary from chronic fluid retention to acute multiorgan dysfunction and death. In this review, we discuss the morphological, functional, and molecular similarities and differences in RV and LV responses to adverse loading and failure. We further discuss whether LV and RV function and failure can truly be discussed as separate entities and thereby examine interactions between the ventricles that on one hand contribute to ventricular dysfunction but on the other may be harnessed for therapeutic benefit. Embryological and Physiological Differences Between the RV and LVThe RV and LV have different embryological origins.1 The LV originates from the primary heart field; the RV, from the secondary heart field. Consequently, several genes specifically control RV formation, including, among others, Hand2 and Tbx20.2 During gestation, the RV functions as the systemic ventricle ( Figure 1A). During fetal life, in addition to supplying the modest amount of pulmonary blood flow, the RV pumps blood to the lower body and placenta and contributes more than half of the combined cardiac output.3 With the transition from fetal to postnatal physiology and with the reduction in pulmonary vascular resistance, the subpulmonary RV transforms its morphology and geometry, becoming a thin-walled chamber to adopt its postnatal physiological characteristics. 4 Because it faces a low impedance pulmonary circulation, the normal postnatal RV maintains a cardiac output equal to that of the LV at approximately a fifth of the energy cost. The trapezoidal RV pressure-volume loop reflects this difference, with few if any isovolumic periods. Consequently, RV output starts early during pressure generation and is later maintained by a "hangout period" when antegrade flow continues into the pulmonary artery despite the onset of RV relaxation.5 In contrast, the rectangular LV pressure-volume loops reflect the LV square-wave pump function with distinct and well-developed isovolumic contraction and relaxation periods.6 Likewise, RV myocytes display faster twitch velocities than LV myocytes. 7The physiological differences are reflected in morphological differences between the ventricles (Table 1). The low-pressure RV is triangular in the sagittal plane and crescent-shaped in cross section as a result of the concave RV free wall and convex interventricular septum wrapping around the high-pressured, thick-walled, bullet-shaped LV. Consequently, although the normal RV has a lower ratio of volume to surface area and a thinner wall than the LV, 8 the low cavity pressure determines a lower wall stress and lower oxygen demands.Anatomic differences are also apparent in myocardial architecture. LV subepicardial and subendocardial fibers are oblique and helical with fiber angles ranging from 30° to 80° with a mean of ≈60°, whereas ...

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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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confidence: 99%

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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Prevalence and Correlates of Septal Delayed Contrast Enhancement in Patients With Pulmonary Hypertension†

Cited by 112 publications

References 19 publications

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Right Versus Left Ventricular Failure

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

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