Karthigesh Sree Raman1,2,3,4, Ranjit Shah1,2,3, Michael Stokes5, Angela Walls6, Richard J Woodman7, Rebecca Perry1,2,3, Jennifer G Walker2, Susanna Proudman8, Carmine G De Pasquale1,2, David S Celermajer9,10, Joseph B Selvanayagam11,12,13. 1. College of Medicine and Public Health, Flinders University, Adelaide, Australia. 2. Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, South Australia, 5042, Australia. 3. Cardiac Imaging Research, South Australian Health & Medical Research Institute, Adelaide, Australia. 4. Department of Medicine (Northland Campus), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand. 5. Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia. 6. Clinical Research and Imaging Centre, South Australian Health & Medical Research Institute, Auckland, Australia. 7. Flinders Centre of Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, Australia. 8. Rheumatology Unit, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, Australia. 9. Sydney Medical School, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia. 10. Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia. 11. College of Medicine and Public Health, Flinders University, Adelaide, Australia. Joseph.Selvanayagam@flinders.edu.au. 12. Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, South Australia, 5042, Australia. Joseph.Selvanayagam@flinders.edu.au. 13. Cardiac Imaging Research, South Australian Health & Medical Research Institute, Adelaide, Australia. Joseph.Selvanayagam@flinders.edu.au.
Abstract
BACKGROUND: In pulmonary arterial hypertension (PAH), progressive right ventricular (RV) dysfunction is believed to be largely secondary to RV ischaemia. A recent pilot study has demonstrated the feasibility of Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) to detect in-vivo RV myocardial oxygenation. The aims of the present study therefore, were to assess the prevalence of RV myocardial ischaemia and relationship with RV myocardial interstitial changes in PAH patients with non-obstructive coronaries, and corelate with functional and haemodynamic parameters. METHODS: We prospectively recruited 42 patients with right heart catheter (RHC) proven PAH and 11 healthy age matched controls. The CMR examination involved standard functional imaging, OS-CMR imaging and native T1 mapping. An ΔOS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments. T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at the inferior RV segment. RESULTS: The inferior RV ΔOS-CMR SI index was significantly lower in PAH patients compared with healthy controls (9.5 (- 7.4-42.8) vs 12.5 (9-24.6)%, p = 0.02). The inferior RV ΔOS-CMR SI had a significant correlation to RV inferior wall thickness (r = - 0.7, p < 0.001) and RHC mean pulmonary artery pressure (mPAP) (r = - 0.4, p = 0.02). Compared to healthy controls, patients with PAH had higher native T1 in the inferior RV wall: 1303 (1107-1612) vs 1232 (1159-1288)ms, p = 0.049. In addition, there was a significant difference in the inferior RV T1 values between the idiopathic PAH and systemic sclerosis associated PAH patients: 1242 (1107-1612) vs 1386 (1219-1552)ms, p = 0.007. CONCLUSION: Blunted OS-CMR SI suggests the presence of in-vivo microvascular RV dysfunction in PAH patients. The native T1 in the inferior RV segments is significantly increased in the PAH patients, particularly among the systemic sclerosis associated PAH group.
BACKGROUND: In pulmonary arterial hypertension (PAH), progressive right ventricular (RV) dysfunction is believed to be largely secondary to RV ischaemia. A recent pilot study has demonstrated the feasibility of Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) to detect in-vivo RV myocardial oxygenation. The aims of the present study therefore, were to assess the prevalence of RV myocardial ischaemia and relationship with RV myocardial interstitial changes in PAH patients with non-obstructive coronaries, and corelate with functional and haemodynamic parameters. METHODS: We prospectively recruited 42 patients with right heart catheter (RHC) proven PAH and 11 healthy age matched controls. The CMR examination involved standard functional imaging, OS-CMR imaging and native T1 mapping. An ΔOS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments. T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at the inferior RV segment. RESULTS: The inferior RV ΔOS-CMRSI index was significantly lower in PAH patients compared with healthy controls (9.5 (- 7.4-42.8) vs 12.5 (9-24.6)%, p = 0.02). The inferior RV ΔOS-CMRSI had a significant correlation to RV inferior wall thickness (r = - 0.7, p < 0.001) and RHC mean pulmonary artery pressure (mPAP) (r = - 0.4, p = 0.02). Compared to healthy controls, patients with PAH had higher native T1 in the inferior RV wall: 1303 (1107-1612) vs 1232 (1159-1288)ms, p = 0.049. In addition, there was a significant difference in the inferior RV T1 values between the idiopathic PAH and systemic sclerosis associated PAH patients: 1242 (1107-1612) vs 1386 (1219-1552)ms, p = 0.007. CONCLUSION: Blunted OS-CMRSI suggests the presence of in-vivo microvascular RV dysfunction in PAH patients. The native T1 in the inferior RV segments is significantly increased in the PAH patients, particularly among the systemic sclerosis associated PAH group.
Entities:
Keywords:
Cardiac magnetic resonance (CMR); Coronary microvascular dysfunction; Oxygen-sensitive cardiac magnetic resonance; Pulmonary artery hypertension; Right ventricle; T1 mapping
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