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Cardiac Magnetic Resonance Derived Left Ventricular Eccentricity Index and Right Ventricular Mass Measurements

Meindina G Haarman1, Iris Coenraad1, Quint A J Hagdorn1

  • 1Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.

Children (Basel, Switzerland)
|May 16, 2023
PubMed

Insights

Cardiac MRI measures of right ventricular function and remodeling predict survival in pediatric idiopathic/heritable pulmonary arterial hypertension (PAH). These findings can aid risk stratification for children with PAH.

Area of Science:

  • Cardiology
  • Pediatric Imaging
  • Pulmonary Hypertension

Background:

  • Pulmonary arterial hypertension (PAH) significantly impacts right ventricular (RV) function and remodeling, crucial for patient outcomes.
  • Risk stratification in pediatric PAH requires reliable noninvasive prognosticators.
  • The prognostic utility of RV characteristics from cardiac magnetic resonance (CMR) in pediatric PAH is underexplored.

Purpose of the Study:

  • To identify CMR-derived morphometric and functional RV characteristics that predict outcomes in children with PAH.
  • To assess the prognostic value of specific RV parameters in pediatric patients with idiopathic/heritable PAH (IPAH/HPAH) and PAH associated with congenital heart disease (PAH-CHD).

Main Methods:

  • Retrospective analysis of CMR data from 38 children with severe PAH (IPAH/HPAH or PAH-CHD).
  • Evaluated RV ejection fraction (RVEF), indexed RV mass (RVMi), RV/LV mass ratio (RVM/LVM-ratio), and left ventricular eccentricity index (LVEI).
  • Correlated these parameters with transplant-free survival.

Main Results:

  • In children with IPAH/HPAH, RVEF, RVMi, RVM/LVM-ratio, and LVEI were significantly correlated with transplant-free survival.
  • These correlations were not observed in the PAH-CHD subgroup.
  • Patients presented with severe PAH, indicated by WHO Functional Class, elevated NT-proBNP, and high PAP/PVRi.

Conclusions:

  • CMR-derived RV function and remodeling metrics (LVEI, RVMi, RVM/LVM-ratio, RVEF) are prognostic for transplant-free survival in pediatric IPAH/HPAH.
  • These imaging parameters hold potential for inclusion in risk stratification scores for pediatric PAH management.

Keywords:
cardiac magnetic resonanceoutcomepediatric pulmonary hypertension

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