Interventricular septal displacement in the assessment of right ventricular dysfunction and pressure overload in patients with pulmonary arterial hypertension. A CMR study.

Congress:

ESCR 2013

Poster Number:

435

Type:

Poster Presentation

Keywords:

Cardiac, Cardiovascular system, Pulmonary vessels, MR, MR-Functional imaging, Ultrasound, Diagnostic procedure, Tissue characterisation, Pathology

Authors:

A. Kallifatidis¹, S. A. Mouratoglou¹, G. Giannakoulas¹, V. Kamperidis¹, I. Grapsa², G. Pitsiou ¹, I. Stanopoulos¹, N. Magganaris¹, S. Hadjimiltiades¹, H. Karvounis¹; ¹Thessaloniki/GR, ²London/UK

DOI:

DOI-Link:

https://dx.doi.org/

Fig. 1: Short-axis SSFP image, presenting interventricular septal displacement towards...

Fig. 2: CMR-TAPSE determination: 4 chamber SSFP image in end-diastolic (A) and...

Fig. 3: Short-axis SSFP image in end diastole, presenting left and right ventrticular...

Fig. 4: Short-axis SSFP image, presenting radius calculation used for the determination...

Fig. 5: Graph presenting correlation between CDi predicted (according to Echo-TAPSE)...

Purpose

Right ventricular pressure overload results in interventricular septal displacement (IVSD) towards left ventricle (Fig.1) in patients with pulmonary arterial hypertension (PAH). There is however scarce data on the duration of IVSD during cardiac cycle as expressed by curvature duration index (CDi) and its potential role in the evaluation of PAH patients. The aim of our study is to reveal the potential value of CDi as a marker of RV function and pressure overload.

Methods and Materials

All patients underwent cardiac magnetic resonance (CMR, Avanto Siemens 1,5T) for the determination of CDi (duration of septal curvature configuration x100/cardiac cycle duration), tricuspid annular plane systolic excursion (CMR-TAPSE) (Fig.2), left ventricular eccentricity index in end-systole (LVSei) and end-diastole (LVDei) (Fig.3), interventricular septal curvature ratio (CR) (Fig.4), left ventricular stroke volume (LVSV) and cardiac output (CO), and echocardiography for the assessment of echo-TAPSE.

Results

Results Our study included 16 patients with PAH (12 women, mean age 46.3±12.5years). A direct linear correlation between CDi and CMR-TAPSE (r=-0.713, p=0.004), CR (r=-0.677, p=0.006), LVSei (r=0.660, p=0.007) and LVDei (r=0.546, p=0.043), LVSV (r=-0.527, p=0.044), CO (r=-0.539, p=0.038) and echo-TAPSE (r=-0.713, p=0.004) was observed (Table). Bivariate correlation mean±SD r CDi (%) 66.8±19.5 CMR-TAPSE (cm) 1.4±0.4 -0.713** CR 0.6±0.2 -0.677** LVSei 1.7±0.5 0.660** LVDei 1.4±0.2 0.546* LVSV 71.0±15.7 -0.527* CO 5.7±1.3 -0.539* Echo-TAPSE (cm) 1.8±0.3 -0.713** Table: linear correlation between CDi and CMR- and echo-derived...

Conclusion

CDi showed strong correlation with well recognized and established markers of right ventricularpressure overload (CR, LVSei, LVDei) andfunction also used as predictors of survival and functional capacity in PAH patients(Echo-TAPSE), as well as with markers ofleft ventricular function (LVSV, CO). CDi could be used as a potential non invasive simple and reproducible marker for the evaluation of RV pressure overload and biventricular function in PAH patients.

References

1.Dellegrottaglie S,Sanz J,Poon M,Viles-Gonzalez JF,Sulica R,Goyenechea M,Macaluso F,Fuster V,Rajagopalan S. Pulmonary hypertension:accuracy of detection with left ventricular septal-to-free wall curvature ratio measured at cardiac MRI.Radiology.2007 Apr;243(1):63-9. 2.Chen SS,Keegan J,Dowsey AW,Ismail T,Wage R,Li W,Yang GZ,Firmin DN,Kilner PJ. Cardiovascularmagneticresonancetaggingof therightventricularfreewallfor theassessmentoflongaxismyocardialfunctionincongenitalheartdisease.J Cardiovasc Magn Reson.2011 Dec 14;13:80. 3.Méndez C,Soler R,Rodriguez E,López M,Alvarez L,Fernández N,Montserrat L. Magneticresonanceimagingofabnormalventricularseptalmotioninheartdiseases: apictorialreview.InsightsImaging.2011 Aug;2(4):483-492 4.Marrone G,Mamone G,Luca A,Vitulo P,Bertani A,Pilato M,Gridelli B. Theroleof1.5TcardiacMRIin thediagnosis,prognosisandmanagementof pulmonaryarterialhypertension. Int J Cardiovasc Imaging.2010 Aug;26(6):665-81. 5.Forfia PR,Fisher MR,Mathai SC,Housten-Harris T,Hemnes AR,Borlaug BA,Chamera E,Corretti MC,Champion HC,Abraham TP,Girgis RE,Hassoun PM. Tricuspidannulardisplacementpredictssurvivalinpulmonaryhypertension.Am...