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. 2021 Jun:139:109679.
doi: 10.1016/j.ejrad.2021.109679. Epub 2021 Mar 26.

Cine MRI characterizes HFpEF and HFrEF in post-capillary pulmonary hypertension

Kai Lin  1 , Roberto Sarnari  2 , Ashitha Pathrose  2 , Daniel Z Gordon  2 , Julie Blaisdell  2 , Michael Markl  2 , James C Carr  2
Affiliations

Cine MRI characterizes HFpEF and HFrEF in post-capillary pulmonary hypertension

Kai Lin et al. Eur J Radiol. 2021 Jun.

Abstract

Purpose: To test the hypothesis that cine MRI can be used to characterize features of left and right ventricles in post-capillary pulmonary hypertension (PH) caused by heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).

Methods: With the approval of institution review board (IRB), 28 consecutive post-capillary PH patients (11 males, 62.1 ± 13.4 years old, range 39-89 years old) underwent cine MRI scans. Cine MRI-derived left ventricular (LV) ejection fraction (LVEF) and other function, motion, and deformation indices (acquired with heart deformation analysis [HDA]) were compared between PH-HFpEF (defined as LVEF ≥ 50 %]) and PH-HFrEF (LVEF < 50 %) patients and were related with right ventricular (RV) indices and right heart catheterization (RHC)-derived pulmonary artery measurements.

Results: Totally 19 patients (68 %, 95 % confident interval [CI] 49 %-86 %) were assigned to PH-HFpEF group while 9 (32 %) was assigned to the PH-HFrEF group. There were differences of LV and right ventricular (RV) global functional indices, LV mass, LV displacement, velocity, strain and strain rate between the two patient groups. Cine MRI-derived LV indices had broad associations with RV indices and RHC measurements. LVEF was negatively correlated with pulmonary capillary wedge pressure (PCWP) (r = -0.5, p = 0.007). LV cardiac index (LVCI) was associated with systolic pulmonary artery pressure (sPAP) (r = 0.443, p = 0.018).

Conclusions: PH-HFpEF and PH-HFrEF patients present dissimilar function, motion and deformation features in LV and RV. Cine MRI-derived LV measures are correlated with hemodynamic abnormalities of PH.

Keywords: Cine MRI; HFpEF; HFrEF; Heart deformation analysis; Post-capillary pulmonary hypertension.

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Figures

Figure 1
Figure 1
Time curves through a cardiac cycle (25 phases from cine images) showed that a PH-HFpEF patient (female, 58 years old, LVEF = 70%, mPAP = 47 mmHg, PCWP = 20 mmHg, PVR = 3.32 wood units) had high peak values in systole (phases 1 – 11), early (phases 12 – 18) and late diastole (phases 19 – 25) than a PH-HFrEF patient (female, 73 years old, LVEF =35%, mPAP = 35 mmHg, PCWP = 23 mmHg, PVR = 3.46 wood units) in radial (A) and circumferential (B) strain rates.
Figure 1
Figure 1
Time curves through a cardiac cycle (25 phases from cine images) showed that a PH-HFpEF patient (female, 58 years old, LVEF = 70%, mPAP = 47 mmHg, PCWP = 20 mmHg, PVR = 3.32 wood units) had high peak values in systole (phases 1 – 11), early (phases 12 – 18) and late diastole (phases 19 – 25) than a PH-HFrEF patient (female, 73 years old, LVEF =35%, mPAP = 35 mmHg, PCWP = 23 mmHg, PVR = 3.46 wood units) in radial (A) and circumferential (B) strain rates.
Figure 2
Figure 2
Cine MRI-derived left heart indices were linearly related with right heart measurements presenting the severity of PH.
Figure 2
Figure 2
Cine MRI-derived left heart indices were linearly related with right heart measurements presenting the severity of PH.
See this image and copyright information in PMC

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