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Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance.
Heart. 2011 Aug; 97(15):1250-6.H

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 (RVEF(ratio)) 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 RVEF(ratio) (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 RVEF(ratio) 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.

Authors+Show Affiliations

The Zena and Michael A Wiener Cardiovascular Institute and Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21672942

Citation

Fernandez-Friera, Leticia, et al. "Apical Right Ventricular Dysfunction in Patients With Pulmonary Hypertension Demonstrated With Magnetic Resonance." Heart (British Cardiac Society), vol. 97, no. 15, 2011, pp. 1250-6.
Fernandez-Friera L, Garcia-Alvarez A, Guzman G, et al. Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. Heart. 2011;97(15):1250-6.
Fernandez-Friera, L., Garcia-Alvarez, A., Guzman, G., Bagheriannejad-Esfahani, F., Malick, W., Nair, A., Fuster, V., Garcia, M. J., & Sanz, J. (2011). Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. Heart (British Cardiac Society), 97(15), 1250-6. https://doi.org/10.1136/hrt.2010.216101
Fernandez-Friera L, et al. Apical Right Ventricular Dysfunction in Patients With Pulmonary Hypertension Demonstrated With Magnetic Resonance. Heart. 2011;97(15):1250-6. PubMed PMID: 21672942.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR 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, Y1 - 2011/06/14/ PY - 2011/6/16/entrez PY - 2011/6/16/pubmed PY - 2011/11/4/medline SP - 1250 EP - 6 JF - Heart (British Cardiac Society) JO - Heart VL - 97 IS - 15 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 (RVEF(ratio)) 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 RVEF(ratio) (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 RVEF(ratio) 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. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/21672942/Apical_right_ventricular_dysfunction_in_patients_with_pulmonary_hypertension_demonstrated_with_magnetic_resonance_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=21672942 DB - PRIME DP - Unbound Medicine ER -