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Published on: February 3, 2014
Left Ventricular Fibrosis Assessment by Native T1, ECV, and LGE in Pulmonary Hypertension Patients
John W Cerne1, Ashitha Pathrose1, Roberto Sarnari1
1Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA.
Abstract:
Cardiac magnetic resonance imaging (MRI) is emerging as an alternative to right heart catheterization for the evaluation of pulmonary hypertension (PH) patients. The aim of this study was to compare cardiac MRI-derived left ventricle fibrosis indices between pre-capillary PH (PrePH) and isolated post-capillary PH (IpcPH) patients and assess their associations with measures of ventricle function. Global and segmental late gadolinium enhancement (LGE), longitudinal relaxation time (native T1) maps, and extracellular volume fraction (ECV) were compared among healthy controls (N = 25; 37% female; 52 ± 13 years), PH patients (N = 48; 60% female; 60 ± 14 years), and PH subgroups (PrePH: N = 29; 65% female; 55 ± 12 years, IpcPH: N = 19; 53% female; 66 ± 13 years). Cardiac cine measured ejection fraction, end diastolic, and end systolic volumes and were assessed for correlations with fibrosis. LGE mural location was qualitatively assessed on a segmental basis for all subjects. PrePH patients had elevated (apical-, mid-antero-, and mid-infero) septal left ventricle native T1 values (1080 ± 74 ms, 1077 ± 39 ms, and 1082 ± 47 ms) compared to IpcPH patients (1028 ± 53 ms, 1046 ± 36 ms, 1051 ± 44 ms) (p < 0.05). PrePH had a higher amount of insertional point LGE (69%) and LGE patterns characteristic of non-vascular fibrosis (77%) compared to IpcPH (37% and 46%, respectively) (p < 0.05; p < 0.05). Assessment of global LGE, native T1, and ECV burdens did not show a statistically significant difference between PrePH (1.9 ± 2.7%, 1056.2 ± 36.3 ms, 31.2 ± 3.7%) and IpcPH (2.7 ± 2.7%, 1042.4 ± 28.1 ms, 30.7 ± 4.7%) (p = 0.102; p = 0.229 p = 0.756). Global native T1 and ECV were higher in patients (1050.9 ± 33.8 and 31.0 ± 4.1%) than controls (28.2 ± 3.7% and 1012.9 ± 29.4 ms) (p < 0.05). Cardiac MRI-based tissue characterization may augment understanding of cardiac involvement and become a tool to facilitate PH patient classification.
Insights
Cardiac MRI reveals distinct left ventricle fibrosis patterns in pre-capillary pulmonary hypertension (PH) compared to isolated post-capillary PH. These findings may improve PH patient classification using non-invasive imaging.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Pulmonary Hypertension Research
Background:
- Pulmonary hypertension (PH) diagnosis and management often rely on invasive procedures like right heart catheterization.
- Cardiac magnetic resonance imaging (MRI) offers a non-invasive alternative for evaluating cardiac involvement in PH.
- Understanding cardiac tissue characteristics in different PH subtypes is crucial for accurate classification and treatment.
Purpose of the Study:
- To compare cardiac MRI-derived left ventricle fibrosis indices between pre-capillary PH (PrePH) and isolated post-capillary PH (IpcPH) patients.
- To assess the association of these fibrosis indices with ventricular function measures.
- To explore the potential of cardiac MRI for differentiating PH subtypes.
Main Methods:
- Cardiac MRI was used to assess global and segmental late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume fraction (ECV).
- Measurements were compared between healthy controls, PH patients, and PH subgroups (PrePH and IpcPH).
- Correlations between fibrosis indices and cardiac function parameters (ejection fraction, volumes) were analyzed.
Main Results:
- PrePH patients exhibited elevated septal left ventricle native T1 values and a higher prevalence of insertional point LGE and non-vascular fibrosis patterns compared to IpcPH patients.
- No significant differences in global LGE, native T1, or ECV burdens were found between PrePH and IpcPH groups.
- Global native T1 and ECV were significantly higher in PH patients compared to healthy controls.
Conclusions:
- Cardiac MRI-derived tissue characterization, particularly segmental native T1 values and LGE patterns, can help differentiate between PrePH and IpcPH.
- These findings suggest that cardiac MRI can augment the understanding of cardiac involvement in PH.
- Cardiac MRI holds promise as a tool to facilitate PH patient classification and potentially guide therapeutic strategies.
