Prognostic value of cardiovascular magnetic resonance derived right ventricular function in patients with interstitial lung disease

Abstract

BackgroundCardiovascular magnetic resonance (CMR) provides non-invasive and more accurate assessment of right ventricular (RV) function in comparison to echocardiography. Recent study demonstrated that assessment of RV function by echocardiography was an independent predictor for mortality in patients with interstitial lung disease (ILD). The purpose of this study was to determine the prognostic significance of CMR derived RV ejection fraction (RVEF) in ILD patients.MethodsWe enrolled 76 patients with ILD and 24 controls in the current study. By using 1.5 T CMR scanner equipped with 32 channel cardiac coils, we performed steady-state free precession cine CMR to assess the RVEF. RV systolic dysfunction (RVSD) was defined as RVEF ≤45.0% calculated by long axis slices. Pulmonary hypertension (PH) was defined as mean pulmonary artery pressure (mPAP) of more than 25 mmHg at rest in the setting of pulmonary capillary wedge pressure ≤15 mmHg.ResultsThe median RVEF was 59.2% in controls (n = 24), 53.8% in ILD patients without PH (n = 42) and 43.1% in ILD patients with PH (n = 13) (p < 0.001 by one-way ANOVA). During a mean follow-up of 386 days, 18 patients with RVSD had 11 severe events (3 deaths, 3 right heart failure, 3 exacerbation of dyspnea requiring oxygen, 2 pneumonia requiring hospitalization). In contrast, only 2 exacerbation of dyspnea requiring oxygen were observed in 58 patients without RVSD. Multivariate Cox regression analysis showed that RVEF independently predicted future events, after adjusting for age, sex and RVFAC by echocardiography (hazard ratio: 0.889, 95% confidence interval: 0.809 – 0.976, p = 0.014).ConclusionsThe current study demonstrated that RVSD in ILD patients can be clearly detected by cine CMR. Importantly, low prevalence of PH (17%) indicated that population included many mild ILD patients. CMR derived RVEF might be useful for the risk stratification and clinical management of ILD patients.

Pulmonary vascular resistance estimated by Doppler echocardiography predicts mortality in patients with interstitial lung disease

“…death, HF, and pneumonia requiring hospitalization) in ILD patients with RV ejection fraction derived by cardiac magnetic resonance imaging (CMR) but not with TAPSE or RV fractional area change determined by echocardiography. Similar to the findings in that study [28], RV s 0 and TAPSE were also not selected as predictors of mortality in the present study ( Table 2). Taken together, the findings suggest that determination of RV systolic function by a more accurate and reproducible modality (e.g.…”

“…This low rate of RV dilation might account for the lack of predictive value of RV dilatation for mortality in the present study. Kato et al [28] recently demonstrated a significant association of hard events (e.g. death, HF, and pneumonia requiring hospitalization) in ILD patients with RV ejection fraction derived by cardiac magnetic resonance imaging (CMR) but not with TAPSE or RV fractional area change determined by echocardiography.…”

Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

“…Assessment of RV function remains problematic because of the chamber's complex anatomical features and the impact of loading and pressure conditions. Although magnetic resonance imaging (MRI) is known to be more accurate [19][20][21], echocardiography remains an indispensable, cost-effective, and practical imaging tool for assessment of RV systolic function [22]. Among the parameters used to assess RV function, FAC, TAPSE, and RV myocardial performance index are useful and reproducible measures of RV systolic function [22,23].…”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…Pulmonary hypertension was defined by right heart catheterization [211]. The median RVEF was lower in ILD patients with PH (43.1 %) compared to those without PH (53.8 %).…”