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Right Ventricular to Left Ventricular (RV/LV) Blood Pool T2 Ratio Is Associated With Invasive Hemodynamics Across
Ipek Buber1,2, Paul Heerdt3, Inderjit Singh4
1Department of Radiology and Biomedical Imaging Yale University New Haven Connecticut USA.
Pulmonary Circulation
|August 8, 2026
Summary
The right-to-left ventricular T2 ratio (T2RV/LV) measured by MRI is a non-invasive biomarker for pulmonary hypertension (PH). This MRI-derived ratio correlates with invasive measures and can aid in risk stratification and treatment monitoring for PH patients.
Area of Science:
- Cardiology
- Radiology
- Pulmonary Medicine
Background:
- Pulmonary hypertension (PH) diagnosis relies on invasive hemodynamic measurements.
- Pulmonary vascular resistance (PVR) and mixed venous oxygenation (SvO2) are critical for assessing PH severity and prognosis.
- The right-to-left ventricular T2 ratio (T2RV/LV) via MRI is a potential non-invasive surrogate for SvO2.
Purpose of the Study:
- To evaluate the T2RV/LV ratio as a non-invasive biomarker for PH.
- To assess the correlation between T2RV/LV and invasive hemodynamic parameters.
- To determine if T2RV/LV can independently predict PH severity.
Main Methods:
- 31 PH patients and 25 controls underwent 1.5T MRI for T2 mapping and volumetric analysis.
- Blood T2RV/LV was measured on mid-ventricular short-axis images.
- MRI data were compared with recent right heart catheterization (RHC) hemodynamic data.
Main Results:
- T2RV/LV was significantly lower in PH patients compared to controls (0.76 vs. 0.91, p < 0.001).
- T2RV/LV strongly correlated with SvO2 (r=0.77), PVR (ρ=-0.74), mPAP (r=-0.54), and RVEF (r=-0.61).
- T2RV/LV independently predicted mPAP and PVR in multivariable analysis, demonstrating excellent inter- and intra-observer reliability.
Conclusions:
- Blood T2RV/LV is a reliable non-invasive biomarker for SvO2 in PH.
- This MRI-derived ratio independently predicts invasive hemodynamic indices, including mPAP and PVR.
- T2RV/LV shows promise for non-invasive risk stratification and treatment monitoring in pulmonary hypertension.
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