Role of Cardiac Magnetic Resonance Imaging in Assessment of Right Ventricular Dysfunction in Patients With Pulmonary Hypertension

Abstract

Background: Patients with pulmonary hypertension (PH) can develop cor pulmonale later which is the leading cause of death in those patients. Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, magnetic resonance imaging (MRI) has emerged as the gold standard for quantifying volume, function, and flow in the right side of the heart.Objective: To evaluate the role of cardiac magnetic resonance image in assessment of right ventricular functions in patients with pulmonary hypertension and to explore the relation between pulmonary artery pressures obtained from echocardiography and MRI -derived ventricular functions parameters. Patients and methods:A total number of 27 patients scheduled for elective conventional echocardiography with known or suspected pulmonary hypertension were enrolled for MRI examination of the heart between October 2018 and March 2020, in Radiology Department, Al-Hussein University Hospital. All patients underwent cardiac MRI and echo within one week. Results:We found that the mean value of left ventricular end systolic volume (LVESV) and left ventricular end systolic volume index (LVESVI) increased in pulmonary hypertensive patients. On assessment of the right ventricular mass index, the mean value was increased in our study compared to normal value. Right ventricular (RV) ventricular mass index (VMI) increased due to increased RV mass and decrease left ventricular (LV) mass. We visually assessed the position of the interventricular septum (IVS) during systole and diastole and had an abnormal position in some patients (nearly 38% of our cases either flattening or bowing toward the left ventricle). All of patients with abnormal septal position had systolic pulmonary pressure above 60 mmHg. We found that 79% of our patients had pulmonary regurge and the average velocity in the main pulmonary was 9.024±6 cm/sec which was less than normal average velocity (13.6±7cm/sec).There was a significant positive correlation between the mean pulmonary arterial pressure (mPAP), and the RV mass(r=0.4), and a significant positive correlation between mPAP and VMI (r=0.52). Conclusion:Cardiac MRI is a valuable tool to assess the effect of pulmonary hypertension on the ventricular functions and also valuable for assessment of treatment response, follow up and prognosis of such patients.