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. 2022 Feb;12(2):894-905.
doi: 10.21037/qims-21-385.

Right ventricular end-systolic remodeling index on cardiac magnetic resonance imaging: comparison with other functional markers in patients with chronic thromboembolic pulmonary hypertension

Ling Zhang  1 , Jinzhu Dai  1 , Peiyao Zhang  1 , Haiyi Ma  1 , Xincao Tao  2 , Yanan Zhen  3 , Xiaopeng Liu  3 , Wanmu Xie  2 , Jun Wan  2 , Min Liu  1
Affiliations

Right ventricular end-systolic remodeling index on cardiac magnetic resonance imaging: comparison with other functional markers in patients with chronic thromboembolic pulmonary hypertension

Ling Zhang et al. Quant Imaging Med Surg. 2022 Feb.

Abstract

Background: Cardiac magnetic resonance imaging (CMR) can provide important metrics of pulmonary hypertension. In the current study, we investigated whether the CMR-derived right ventricular end-systolic remodeling index (RVESRI) could be a metric in assessing the function and hemodynamics of chronic thromboembolic pulmonary hypertension (CTEPH).

Methods: A total of 64 patients (45±14 years, 37 males), including 46 patients with CTEPH and 18 patients with chronic pulmonary thromboembolism (CTE), were retrospectively enrolled. All patients underwent right heart catheterization and CMR within 7 days. RVESRI, right ventricular eccentricity index, right ventricular end-diastolic and end-systolic volume index, right ventricular ejection fraction, right ventricular cardiac output, and strain were analyzed on cine images of CMR. Hemodynamic parameters including mean pulmonary arterial pressure, pulmonary vascular resistance, and cardiac output were obtained from right heart catheterization.

Results: RVESRI of all patients was 1.50 (IQR, 1.26-1.90). Compared with CTE patients, RVESRI in patients with CTEPH was significantly increased (U=27.5, P<0.001). The interclass correlation coefficients of intra-observer reproducibility and inter-observer reproducibility for RVESRI measurement were 0.96 (95% CI, 0.93-0.97) and 0.99 (95% CI, 0.98-0.99), respectively. RVESRI positively correlated with right ventricular end-diastolic and end-systolic volume index and right ventricular global longitudinal strain (r=0.79, 0.83, 0.62, P<0.001), while it was negatively correlated with right ventricular ejection fraction (r=-0.64, P<0.001), right ventricular cardiac output (r=-0.50, P<0.001), and right ventricular eccentricity index (r=-0.81, P<0.001). RVESRI had a positive correlation with mean pulmonary arterial pressure (r=0.65, P<0.001) and pulmonary vascular resistance (r=0.69, P<0.001), while it was negatively correlated with cardiac output (r=-0.64, P<0.001). The receiver operating characteristic curve indicated that RVESRI >1.35 had a sensitivity of 97.8% and specificity of 83.3% in predicting mean pulmonary arterial pressure ≥25 mmHg, and its area under the curve (AUC) was 0.96±0.02. Meanwhile, the AUC of RVESRI was similar to RVEI (Z=1.635, P=0.102) and was more than the diameter of the main pulmonary artery (MPA) (Z=2.26, P=0.02) and the ratio of the MPA and ascending aorta diameter (MPA/AAo) (Z=3.826, P<0.001) in predicting mean pulmonary arterial pressure ≥25 mmHg.

Conclusions: RVESRI measured on CMR is a simple and reproducible metric in assessing right ventricular function and hemodynamics in CTEPH patients.

Keywords: Chronic thromboembolic pulmonary hypertension; RV end-systolic remodeling index; cardiovascular magnetic resonance; hemodynamics; right ventricular function.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/qims-21-385). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The flowchart of the study. CTEPH, chronic thromboembolic pulmonary hypertension; CTE, chronic pulmonary thromboembolism; CMR, cardiac magnetic resonance imaging; RHC, right heart catheterization.
Figure 2
Figure 2
Measurement of right ventricular end-systolic remodeling index (RVESRI) on the 4-chamber cine image of cardiac magnetic resonance imaging (CMR) in end systole. RVESRI was the ratio of end-systolic lateral free wall length (red line) to interventricular septal height (blue line).
Figure 3
Figure 3
Reproducibility of right ventricular end-systolic remodeling index (RVESRI) measurements by Bland-Altman plots. (A) Measurements of RVESRI by 2 independent observers and (B) measurements of RVESRI twice by one observer.
Figure 4
Figure 4
Correlation analysis of the right ventricular end-systolic remodeling index (RVESRI) with plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and 6-minute walk distance (6MWD). (A) RVESRI positively correlated with plasma NT-proBNP (r=0.85, P<0.001). (B) RVESRI negatively correlated with 6MWD (r=−0.79, P<0.001).
Figure 5
Figure 5
Correlation analysis of right ventricular end-systolic remodeling index (RVESRI) with hemodynamics. (A) RVESRI positively correlated with right atrial pressure (RAP) (r=0.64, P<0.001). (B) RVESRI positively correlated with mean pulmonary arterial pressure (MPAP) (r=0.65, P<0.001). (C) RVESRI positively correlated with pulmonary vascular resistance (PVR) (r=0.69, P<0.001). (D) RVESRI negatively correlated with cardiac output (CO) (r=−0.64, P<0.001).
Figure 6
Figure 6
Performance of right ventricular end-systolic remodeling index (RVESRI), right ventricular eccentricity index (RVEI), right ventricular myocardial mass index (RVMI), the diameter of the main pulmonary artery (MPA), and the ratio of the MPA and ascending aorta diameter (MPA/AAo) for the prediction of mean pulmonary artery pressure ≥25 mmHg as indicated by receiver operating characteristic curves.
See this image and copyright information in PMC

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