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. 2022 Dec 27;13(1):71.
doi: 10.3390/diagnostics13010071.

Left Ventricular Fibrosis Assessment by Native T1, ECV, and LGE in Pulmonary Hypertension Patients

John W Cerne  1 , Ashitha Pathrose  1 , Roberto Sarnari  1 , Manik Veer  1 , Kelvin Chow  2 , Kamal Subedi  1 , Bradley D Allen  1 , Ryan J Avery  1 , Michael Markl  1   3 , James C Carr  1
Affiliations

Left Ventricular Fibrosis Assessment by Native T1, ECV, and LGE in Pulmonary Hypertension Patients

John W Cerne et al. Diagnostics (Basel). .

Abstract

Cardiac magnetic resonance imaging (MRI) is emerging as an alternative to right heart catheterization for the evaluation of pulmonary hypertension (PH) patients. The aim of this study was to compare cardiac MRI-derived left ventricle fibrosis indices between pre-capillary PH (PrePH) and isolated post-capillary PH (IpcPH) patients and assess their associations with measures of ventricle function. Global and segmental late gadolinium enhancement (LGE), longitudinal relaxation time (native T1) maps, and extracellular volume fraction (ECV) were compared among healthy controls (N = 25; 37% female; 52 ± 13 years), PH patients (N = 48; 60% female; 60 ± 14 years), and PH subgroups (PrePH: N = 29; 65% female; 55 ± 12 years, IpcPH: N = 19; 53% female; 66 ± 13 years). Cardiac cine measured ejection fraction, end diastolic, and end systolic volumes and were assessed for correlations with fibrosis. LGE mural location was qualitatively assessed on a segmental basis for all subjects. PrePH patients had elevated (apical-, mid-antero-, and mid-infero) septal left ventricle native T1 values (1080 ± 74 ms, 1077 ± 39 ms, and 1082 ± 47 ms) compared to IpcPH patients (1028 ± 53 ms, 1046 ± 36 ms, 1051 ± 44 ms) (p < 0.05). PrePH had a higher amount of insertional point LGE (69%) and LGE patterns characteristic of non-vascular fibrosis (77%) compared to IpcPH (37% and 46%, respectively) (p < 0.05; p < 0.05). Assessment of global LGE, native T1, and ECV burdens did not show a statistically significant difference between PrePH (1.9 ± 2.7%, 1056.2 ± 36.3 ms, 31.2 ± 3.7%) and IpcPH (2.7 ± 2.7%, 1042.4 ± 28.1 ms, 30.7 ± 4.7%) (p = 0.102; p = 0.229 p = 0.756). Global native T1 and ECV were higher in patients (1050.9 ± 33.8 and 31.0 ± 4.1%) than controls (28.2 ± 3.7% and 1012.9 ± 29.4 ms) (p < 0.05). Cardiac MRI-based tissue characterization may augment understanding of cardiac involvement and become a tool to facilitate PH patient classification.

Keywords: extracellular volume fraction; late gadolinium enhancement; native T1; pulmonary hypertension.

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Conflict of interest statement

J.C.C. is the principal investigator for this Bayer funded study. He declares that he has previously participated in advisory boards for Bayer, Guerbet, and Bracco. He participates in speaking roles sponsored by Bayer. He has received institutional research support sponsored by Bayer, Guerbet, and Siemens. M.M. has received research support from Siemens. He has received research grants from Circle Cardiovascular imaging and Cryolife incorporated. B.D.A. and R.J.A. have performed consulting for Circle Cardiovascular Imaging. K.C. is a full-time employee of Siemens. The other authors declare that they have no competing interests. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
LGE, volumetric, and parametric mapping measurements were obtained with similar workflows. The number of planes obtained, and the traced regions, differed for each analysis.
Figure 2
Figure 2
Box plot representations of LGE, ECV, and native T1 in (patients (n = 48; n = 43; n = 47, respectively) vs. controls (n = 25 in all)) and (PrePH: n = 29; n = 26; n = 29, respectively vs. IpcPH: n = 19; n = 17; n = 18, respectively) vs. controls). Red asterisks indicate statistical significance (p < 0.05).
Figure 3
Figure 3
Target plot representations of myocardial fibrosis burden. (*), p < 0.05 between top and bottom maps.
Figure 4
Figure 4
Target plot representations of myocardial fibrosis burden. (*), p < 0.05 between top and bottom maps.
Figure 5
Figure 5
Of the LGE (+) segments, the distributions of vascular and non-vascular fibrosis were compared between groups. Vascular fibrosis was more characteristic of IpcPH patients than PrePH patients. * = p < 0.05.
See this image and copyright information in PMC

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