Author + information
- Received March 13, 2014
- Revision received August 7, 2014
- Accepted August 15, 2014
- Published online December 1, 2014.
- Andrew J. Swift, PhD∗,†∗ (, )
- Smitha Rajaram, MD∗,
- Dave Capener, MSc∗,
- Charlie Elliot, MBChB‡,
- Robin Condliffe, MD‡,
- Jim M. Wild, PhD∗ and
- David G. Kiely, MD‡
- ∗Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
- †INSIGNEO, Institute for In Silico Medicine, University of Sheffield, United Kingdom
- ‡Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- ↵∗Reprint request and correspondence:
Dr. Andrew J. Swift, Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2J, United Kingdom.
Objectives The goal of this study was to determine the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) features in patients with pulmonary hypertension.
Background The prognostic significance of LGE in the clinical assessment of patients with pulmonary hypertension remains uncertain.
Methods Consecutive patients with suspected pulmonary hypertension seen at a specialist pulmonary hypertension referral center who underwent right heart catheterization and CMR with LGE imaging within 48 h were identified. Short-axis late-enhancement imaging was performed using a 3-dimensional gradient spoiled echocardiography sequence on a 1.5-T scanner. Three groups were identified: 1) no late enhancement of the myocardium; 2) late enhancement at the right ventricular insertion points (LGE-IP); and 3) late enhancement involving the right ventricular insertion points and the interventricular septum (LGE-S).
Results Of 194 patients, 162 had pulmonary hypertension. LGE was identified in 135 of 162 (83%) patients with pulmonary hypertension, and 47 (29%) of patients demonstrated LGE-S. Patients with LGE-S had significantly higher right ventricular end-diastolic volume index (p = 0.013) and lower mixed venous oxygen saturation (p = 0.045) than patients with LGE-IP alone. The presence of LGE-S (p = 0.022), but not LGE-IP alone, right ventricular end-systolic volume (p = 0.045), right ventricular ejection fraction (p = 0.034), mixed venous oxygen saturation (p = 0.021), mean right atrial pressure (0.027), and male sex (p = 0.002) predicted mortality. At multivariate analysis, male sex was the only significant predictor of mortality independent of covariate predictors (p = 0.027).
Conclusions The presence of LGE at the right ventricular insertion points is suggestive of the presence of pulmonary hypertension. LGE may also be more extensive, involving the septum; however, after multivariable analysis including other factors associated with pulmonary hypertension, septal LGE was not associated with an increase in overall mortality.
- cardiac magnetic resonance
- idiopathic pulmonary arterial hypertension
- prognosis right ventricle
- pulmonary hypertension
Dr. Condliffe has received funding for advisory boards from Actelion, GlaxoSmithKline, Bayer and Pfizer; and honoraria and conference fees from Actelion, GlaxoSmithKline, Bayer and Pfizer. Dr. Kiely has received payment for participation in advisory boards from Actelion, Bayer, Chiesi, GlaxoSmithKline, Pfizer, and United Therapeutics; speaker fees from Actelion, Bayer, Chiesi, GlaxoSmithKline, Pfizer, and United Therapeutics; and his department has received unrestricted educational grants to fund staff for education and research from Actelion, Bayer, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2014.
- Revision received August 7, 2014.
- Accepted August 15, 2014.
- American College of Cardiology Foundation