Regional and global biventricular function in pulmonary arterial hypertension

A cardiac MR imaging study

Monda L. Shehata, Ahmed A. Harouni, Jan Skrok, Tamer A. Basha, Danielle Boyce, Noah Lechtzin, Stephen Mathai, Reda Girgis, Nael Fakhry Osman, Joao Lima, David A. Bluemke, Paul M Hassoun, Jens Vogel-Claussen

Research output: Contribution to journalArticle

Abstract

Purpose: To determine whether chronic pulmonary arterial pressure (PAP) elevation affects regional biventricular function and whether regional myocardial function may be reduced in pulmonary arterial hypertension (PAH) patients with preserved global right ventricular (RV) function. Materials and Methods: After informed consent, 35 PAH patients were evaluated with right heart catheterization and cardiac magnetic resonance (MR) imaging and compared with 13 healthy control subjects. Biventricular segmental, section, and mean ventricular peak systolic longitudinal strain (ELL), as well as left ventricular (LV) circumferential and RV tangential strains were compared between PAH patients and control subjects and correlated with global function and catheterization of the right heart indexes. Spearman ρ correlation with Bonferroni correction was used. Multiple linear regression analysis was performed to determine predictors for regional myocardial function. Results: In the RV of PAH patients, longitudinal contractility was reduced at the basal, mid, and apical levels, and tangential contractility was reduced at the midventricular level. Mean RV ELL positively correlated with mean PAP (r = 0.62, P <.0014) and pulmonary vascular resistance index (PVRI) (r = 0.77, P <.0014). Mean PAP was a predictor of mean RV ELL (β = .19, P = .005) in a multiple linear regression analysis. In the LV, reduced LV longitudinal and circumferential contractility were noted at the base. LV anteroseptal ELL positively correlated with increased mean PAP (r = 0.5, P = .03) and septal eccentricity index (r = 0.5, P = .01). In a subgroup of PAH patients with normal global RV function, significantly reduced RV longitudinal contractility was noted at basal and mid anterior septal insertions, as well as the mid anterior RV wall (P <.05 for all). Conclusion: In PAH patients, reduced biventricular regional function is associated with increased RV afterload (mean PAP and PVRI). Cardiac MR imaging helps identify regional RV dysfunction in PAH patients with normal global RV function.

Original languageEnglish (US)
Pages (from-to)114-122
Number of pages9
JournalRadiology
Volume266
Issue number1
DOIs
StatePublished - Jan 2013

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Pulmonary Hypertension
Magnetic Resonance Imaging
Arterial Pressure
Right Ventricular Function
Lung
Cardiac Catheterization
Vascular Resistance
Linear Models
Regression Analysis
Right Ventricular Dysfunction
Informed Consent
Healthy Volunteers

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Shehata, M. L., Harouni, A. A., Skrok, J., Basha, T. A., Boyce, D., Lechtzin, N., ... Vogel-Claussen, J. (2013). Regional and global biventricular function in pulmonary arterial hypertension: A cardiac MR imaging study. Radiology, 266(1), 114-122. https://doi.org/10.1148/radiol.12111599

Regional and global biventricular function in pulmonary arterial hypertension : A cardiac MR imaging study. / Shehata, Monda L.; Harouni, Ahmed A.; Skrok, Jan; Basha, Tamer A.; Boyce, Danielle; Lechtzin, Noah; Mathai, Stephen; Girgis, Reda; Osman, Nael Fakhry; Lima, Joao; Bluemke, David A.; Hassoun, Paul M; Vogel-Claussen, Jens.

In: Radiology, Vol. 266, No. 1, 01.2013, p. 114-122.

Research output: Contribution to journalArticle

Shehata, ML, Harouni, AA, Skrok, J, Basha, TA, Boyce, D, Lechtzin, N, Mathai, S, Girgis, R, Osman, NF, Lima, J, Bluemke, DA, Hassoun, PM & Vogel-Claussen, J 2013, 'Regional and global biventricular function in pulmonary arterial hypertension: A cardiac MR imaging study', Radiology, vol. 266, no. 1, pp. 114-122. https://doi.org/10.1148/radiol.12111599
Shehata, Monda L. ; Harouni, Ahmed A. ; Skrok, Jan ; Basha, Tamer A. ; Boyce, Danielle ; Lechtzin, Noah ; Mathai, Stephen ; Girgis, Reda ; Osman, Nael Fakhry ; Lima, Joao ; Bluemke, David A. ; Hassoun, Paul M ; Vogel-Claussen, Jens. / Regional and global biventricular function in pulmonary arterial hypertension : A cardiac MR imaging study. In: Radiology. 2013 ; Vol. 266, No. 1. pp. 114-122.
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abstract = "Purpose: To determine whether chronic pulmonary arterial pressure (PAP) elevation affects regional biventricular function and whether regional myocardial function may be reduced in pulmonary arterial hypertension (PAH) patients with preserved global right ventricular (RV) function. Materials and Methods: After informed consent, 35 PAH patients were evaluated with right heart catheterization and cardiac magnetic resonance (MR) imaging and compared with 13 healthy control subjects. Biventricular segmental, section, and mean ventricular peak systolic longitudinal strain (ELL), as well as left ventricular (LV) circumferential and RV tangential strains were compared between PAH patients and control subjects and correlated with global function and catheterization of the right heart indexes. Spearman ρ correlation with Bonferroni correction was used. Multiple linear regression analysis was performed to determine predictors for regional myocardial function. Results: In the RV of PAH patients, longitudinal contractility was reduced at the basal, mid, and apical levels, and tangential contractility was reduced at the midventricular level. Mean RV ELL positively correlated with mean PAP (r = 0.62, P <.0014) and pulmonary vascular resistance index (PVRI) (r = 0.77, P <.0014). Mean PAP was a predictor of mean RV ELL (β = .19, P = .005) in a multiple linear regression analysis. In the LV, reduced LV longitudinal and circumferential contractility were noted at the base. LV anteroseptal ELL positively correlated with increased mean PAP (r = 0.5, P = .03) and septal eccentricity index (r = 0.5, P = .01). In a subgroup of PAH patients with normal global RV function, significantly reduced RV longitudinal contractility was noted at basal and mid anterior septal insertions, as well as the mid anterior RV wall (P <.05 for all). Conclusion: In PAH patients, reduced biventricular regional function is associated with increased RV afterload (mean PAP and PVRI). Cardiac MR imaging helps identify regional RV dysfunction in PAH patients with normal global RV function.",
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AU - Shehata, Monda L.

AU - Harouni, Ahmed A.

AU - Skrok, Jan

AU - Basha, Tamer A.

AU - Boyce, Danielle

AU - Lechtzin, Noah

AU - Mathai, Stephen

AU - Girgis, Reda

AU - Osman, Nael Fakhry

AU - Lima, Joao

AU - Bluemke, David A.

AU - Hassoun, Paul M

AU - Vogel-Claussen, Jens

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N2 - Purpose: To determine whether chronic pulmonary arterial pressure (PAP) elevation affects regional biventricular function and whether regional myocardial function may be reduced in pulmonary arterial hypertension (PAH) patients with preserved global right ventricular (RV) function. Materials and Methods: After informed consent, 35 PAH patients were evaluated with right heart catheterization and cardiac magnetic resonance (MR) imaging and compared with 13 healthy control subjects. Biventricular segmental, section, and mean ventricular peak systolic longitudinal strain (ELL), as well as left ventricular (LV) circumferential and RV tangential strains were compared between PAH patients and control subjects and correlated with global function and catheterization of the right heart indexes. Spearman ρ correlation with Bonferroni correction was used. Multiple linear regression analysis was performed to determine predictors for regional myocardial function. Results: In the RV of PAH patients, longitudinal contractility was reduced at the basal, mid, and apical levels, and tangential contractility was reduced at the midventricular level. Mean RV ELL positively correlated with mean PAP (r = 0.62, P <.0014) and pulmonary vascular resistance index (PVRI) (r = 0.77, P <.0014). Mean PAP was a predictor of mean RV ELL (β = .19, P = .005) in a multiple linear regression analysis. In the LV, reduced LV longitudinal and circumferential contractility were noted at the base. LV anteroseptal ELL positively correlated with increased mean PAP (r = 0.5, P = .03) and septal eccentricity index (r = 0.5, P = .01). In a subgroup of PAH patients with normal global RV function, significantly reduced RV longitudinal contractility was noted at basal and mid anterior septal insertions, as well as the mid anterior RV wall (P <.05 for all). Conclusion: In PAH patients, reduced biventricular regional function is associated with increased RV afterload (mean PAP and PVRI). Cardiac MR imaging helps identify regional RV dysfunction in PAH patients with normal global RV function.

AB - Purpose: To determine whether chronic pulmonary arterial pressure (PAP) elevation affects regional biventricular function and whether regional myocardial function may be reduced in pulmonary arterial hypertension (PAH) patients with preserved global right ventricular (RV) function. Materials and Methods: After informed consent, 35 PAH patients were evaluated with right heart catheterization and cardiac magnetic resonance (MR) imaging and compared with 13 healthy control subjects. Biventricular segmental, section, and mean ventricular peak systolic longitudinal strain (ELL), as well as left ventricular (LV) circumferential and RV tangential strains were compared between PAH patients and control subjects and correlated with global function and catheterization of the right heart indexes. Spearman ρ correlation with Bonferroni correction was used. Multiple linear regression analysis was performed to determine predictors for regional myocardial function. Results: In the RV of PAH patients, longitudinal contractility was reduced at the basal, mid, and apical levels, and tangential contractility was reduced at the midventricular level. Mean RV ELL positively correlated with mean PAP (r = 0.62, P <.0014) and pulmonary vascular resistance index (PVRI) (r = 0.77, P <.0014). Mean PAP was a predictor of mean RV ELL (β = .19, P = .005) in a multiple linear regression analysis. In the LV, reduced LV longitudinal and circumferential contractility were noted at the base. LV anteroseptal ELL positively correlated with increased mean PAP (r = 0.5, P = .03) and septal eccentricity index (r = 0.5, P = .01). In a subgroup of PAH patients with normal global RV function, significantly reduced RV longitudinal contractility was noted at basal and mid anterior septal insertions, as well as the mid anterior RV wall (P <.05 for all). Conclusion: In PAH patients, reduced biventricular regional function is associated with increased RV afterload (mean PAP and PVRI). Cardiac MR imaging helps identify regional RV dysfunction in PAH patients with normal global RV function.

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