Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Leticia Fernandez-Friera, Ana Garcia-Alvarez, Gabriela Guzman, Fatemeh Bagheriannejad-Esfahani, Waqas Malick, Ajith Nair, Valentin Fuster, Mario J. Garcia, Javier Sanz

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objective: To evaluate segmental right ventricular (RV) dysfunction in pulmonary hypertension (PH) using cardiac magnetic resonance (CMR). Design: Cross-sectional analysis in a retrospective cohort of consecutive adult patients. Setting: Mount Sinai Hospital in New York. Patients: 192 patients with known or suspected PH undergoing right heart catheterisation and CMR. PH was defined as mean pulmonary artery pressure ≥25 mm Hg. Abnormal RV ejection fraction (RVEF) was defined as <50%. Patients were classified into: group 1 (no PH, normal RVEF; n=40), group 2 (PH, normal RVEF; n=41) or group 3 (PH, abnormal RVEF; n=111). Interventions: CMR and right heart catheterisation within a 2-week interval. Main outcome measures: On cine CMR images, the stack of RV short-axis views was divided into two equal halves. Basal and apical RVEF were calculated using Simpson's method, and a ratio of basal-to-apical RVEF (RVEFratio) was derived. Results: Basal RVEF did not differ between groups 1 and 2 (63±8% vs 64±8%; p=1); however, patients in group 2 had significantly lower apical RVEF (46±13% vs 58±10%; p<0.01) and higher RVEFratio (median 1.4 vs 1.1; p<0.01). Both apical and basal RVEF were reduced in group 3 compared with groups 1 and 2 (p<0.01), and the RVEFratio increased with increasing PH severity (p<0.01 for trend). An apical RVEF <50% was more sensitive than global RV dysfunction for the detection of PH. Conclusions: Apical dysfunction appears to occur before global RVEF decreases in chronic PH, potentially constituting an early and sensitive marker of RV dysfunction in this setting.

Original languageEnglish (US)
Pages (from-to)1250-1256
Number of pages7
JournalHeart
Volume97
Issue number15
DOIs
StatePublished - Aug 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Fernandez-Friera, L., Garcia-Alvarez, A., Guzman, G., Bagheriannejad-Esfahani, F., Malick, W., Nair, A., Fuster, V., Garcia, M. J., & Sanz, J. (2011). Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. Heart, 97(15), 1250-1256. https://doi.org/10.1136/hrt.2010.216101