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 Citations (Scopus)

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
Externally publishedYes

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Right Ventricular Dysfunction
Pulmonary Hypertension
Magnetic Resonance Spectroscopy
Cardiac Catheterization
Stroke Volume
Pulmonary Artery
Cross-Sectional Studies
Outcome Assessment (Health Care)
Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fernandez-Friera, L., Garcia-Alvarez, A., Guzman, G., Bagheriannejad-Esfahani, F., Malick, W., Nair, A., ... 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

Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. / Fernandez-Friera, Leticia; Garcia-Alvarez, Ana; Guzman, Gabriela; Bagheriannejad-Esfahani, Fatemeh; Malick, Waqas; Nair, Ajith; Fuster, Valentin; Garcia, Mario J.; Sanz, Javier.

In: Heart, Vol. 97, No. 15, 08.2011, p. 1250-1256.

Research output: Contribution to journalArticle

Fernandez-Friera, L, Garcia-Alvarez, A, Guzman, G, Bagheriannejad-Esfahani, F, Malick, W, Nair, A, Fuster, V, Garcia, MJ & Sanz, J 2011, 'Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance', Heart, vol. 97, no. 15, pp. 1250-1256. https://doi.org/10.1136/hrt.2010.216101
Fernandez-Friera L, Garcia-Alvarez A, Guzman G, Bagheriannejad-Esfahani F, Malick W, Nair A et al. Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. Heart. 2011 Aug;97(15):1250-1256. https://doi.org/10.1136/hrt.2010.216101
Fernandez-Friera, Leticia ; Garcia-Alvarez, Ana ; Guzman, Gabriela ; Bagheriannejad-Esfahani, Fatemeh ; Malick, Waqas ; Nair, Ajith ; Fuster, Valentin ; Garcia, Mario J. ; Sanz, Javier. / Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. In: Heart. 2011 ; Vol. 97, No. 15. pp. 1250-1256.
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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.",
author = "Leticia Fernandez-Friera and Ana Garcia-Alvarez and Gabriela Guzman and Fatemeh Bagheriannejad-Esfahani and Waqas Malick and Ajith Nair and Valentin Fuster and Garcia, {Mario J.} and Javier Sanz",
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T1 - Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

AU - Fernandez-Friera, Leticia

AU - Garcia-Alvarez, Ana

AU - Guzman, Gabriela

AU - Bagheriannejad-Esfahani, Fatemeh

AU - Malick, Waqas

AU - Nair, Ajith

AU - Fuster, Valentin

AU - Garcia, Mario J.

AU - Sanz, Javier

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N2 - 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.

AB - 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.

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