Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 29;16(11):e0260456.
doi: 10.1371/journal.pone.0260456. eCollection 2021.

Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertension

Ryotaro Asano  1   2   3 , Takeshi Ogo  1   2 , Yoshiaki Morita  4 , Akiyuki Kotoku  4 , Tatsuo Aoki  1 , Kyoko Hirakawa  1 , Sayuri Nakayama  1 , Jin Ueda  1 , Akihiro Tsuji  1 , Mark T Waddingham  2 , Yasutoshi Ohta  4 , Tetsuya Fukuda  4 , Keiko Ohta-Ogo  5 , Hatsue Ishibashi-Ueda  5 , Teruo Noguchi  3   6 , Satoshi Yasuda  3   6
Affiliations

Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertension

Ryotaro Asano et al. PLoS One. .

Abstract

Background: Right ventricular function is an important prognostic marker for pulmonary arterial hypertension. Native T1 mapping using cardiovascular magnetic resonance imaging can characterize the myocardium, but accumulating evidence indicates that T1 values of the septum or ventricular insertion points do not have predictive potential in pulmonary arterial hypertension. We aimed to elucidate whether native T1 values of the right ventricular free wall (RVT1) can predict poor outcomes in patients with pulmonary arterial hypertension.

Methods: This retrospective study included 30 patients with pulmonary arterial hypertension (median age, 45 years; mean pulmonary artery pressure, 41±13 mmHg) and 16 healthy controls (median age, 43 years) who underwent native T1 mapping. RVT1 was obtained from the inferior right ventricular free wall during end systole.

Results: Patients with pulmonary arterial hypertension had significantly higher native RVT1 than did controls (1384±74 vs. 1217±57 ms, p<0.001). Compared with T1 values of the septum or ventricular insertion points, RVT1 correlated better with the effective right ventricular elastance index (R = -0.53, p = 0.003), ventricular-arterial uncoupling (R = 0.46, p = 0.013), and serum brain natriuretic peptide levels (R = 0.65, p<0.001). Moreover, the baseline RVT1 was an accurate predictor of the reduced right ventricular ejection fraction at the 12-month follow-up (delta -3%). RVT1 was independently associated with composite events of death or hospitalization from any cause (hazard ratio = 1.02, p = 0.002).

Conclusions: RVT1 was predictive of right ventricular performance and outcomes in patients with pulmonary arterial hypertension. Thus, native T1 mapping in the right ventricular free wall may be an effective prognostic method for pulmonary arterial hypertension.

PubMed Disclaimer

Conflict of interest statement

We have read the journal’s policy and the authors of this manuscript have the following competing interests: Ryotaro Asano, Takeshi Ogo, and Mark T. Waddingham belong to a department endowed by Nippon Shinyaku Co. The remaining authors have nothing to disclose regarding the publication of this article. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Measurement regions in the right ventricle (RV) and comparisons of T1 values.
(a) ROIs of the septum and VIPs are marked in yellow and orange, respectively. ROIs of the RV free wall evaluated in the inferior part are marked in red. (b) Bar plots of native T1 values at each measurement site. The blue and red bars indicate T1 values of patients with PAH and healthy controls, respectively. (c) Interobserver variability analyzed by the Bland–Altman plot. (d) Correlations between T1 values at each measurement site and effective RV elastance using the single-beat method. (e) Correlations between T1 values at each measurement site and RV-pulmonary arterial coupling. Abbreviations: Ea-pa, effective pulmonary arterial elastance; Ees-rv, effective right ventricular elastance; LV, left ventricle; PAH, pulmonary arterial hypertension; ROI, region of interest; RV, right ventricle; VIPs, interventricular insertion points.
Fig 2
Fig 2. Predictive value of RVT1 for the decreased RV ejection fraction (RVEF) and poor outcome in pulmonary arterial hypertension (PAH).
(a) Study profile. Thirty patients were enrolled (evaluating outcomes), and native T1 mapping using CMR and RHC was performed. Eighteen patients underwent volumetric CMR over a 12-month follow-up period (evaluating changes in RVEF). (b) Relationships between changes in the RVEF and baseline RVT1. (c) The receiver characteristics curve analysis for a decreased RVEF at follow-up. We defined a change of +3% or −3% (between baseline and follow-up over 12 months) as an increased or decreased RVEF, respectively. (d) Survival curves in 30 patients with PAH. Event-free survival was calculated according to native RVT1. Survival rates from events including composite outcomes of death and all hospitalizations, and death and hospitalization due to right heart failure, and each event were significantly reduced in patients with higher RVT1. Abbreviations: AUC, area under the curve; CMR, cardiovascular magnetic resonance; RHC, right heart catheterization; RHF, right heart failure; RVEF, right ventricular ejection fraction; RVT1, native T1 values of the right ventricular free wall.
See this image and copyright information in PMC

References

    1. Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, et al.. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114: 1883–1891. doi: 10.1161/CIRCULATIONAHA.106.632208 - DOI - PubMed
    1. Tonelli AR, Arelli V, Minai OA, Newman J, Bair N, Heresi GA, et al.. Causes and circumstances of death in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2013;188: 365–369. doi: 10.1164/rccm.201209-1640OC - DOI - PMC - PubMed
    1. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al.. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2015;46: 903–975. doi: 10.3410/f.725758087.793519769 - DOI - PubMed
    1. van de Veerdonk MC, Kind T, Marcus JT, Mauritz GJ, Heymans MW, Bogaard HJ, et al.. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol. 2011;58: 2511–2519. doi: 10.1016/j.jacc.2011.06.068 - DOI - PubMed
    1. van de Veerdonk MC, Bogaard HJ, Voelkel NF. The right ventricle and pulmonary hypertension. Heart Fail Rev. 2016;21: 259–271. doi: 10.1007/s10741-016-9526-y - DOI - PubMed

Publication types