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Left ventricular diastolic dysfunction in pulmonary hypertension predicts functional capacity and clinical worsening: a tissue phase mapping study.

Knight DS, Steeden JA, Moledina S, Jones A, Coghlan JG, Muthurangu V - J Cardiovasc Magn Reson (2015)

Bottom Line: Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers.TPM metrics of LV diastolic function are significantly abnormal in PH.More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.

View Article: PubMed Central - PubMed

Affiliation: Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK. danielknight@doctors.org.uk.

ABSTRACT

Background: The function of the right and left ventricles is intimately related through a shared septum and pericardium. Therefore, right ventricular (RV) disease in pulmonary hypertension (PH) can result in abnormal left ventricular (LV) myocardial mechanics. To assess this, we implemented novel cardiovascular magnetic resonance (CMR) tissue phase mapping (TPM) to assess radial, longitudinal and tangential LV myocardial velocities in patients with PH.

Methods: Respiratory self-gated TPM was performed using a rotating golden-angle spiral acquisition with retrospective cardiac gating. TPM of a mid ventricular slice was acquired in 40 PH patients and 20 age- and sex-matched healthy controls. Endocardial and epicardial LV borders were manually defined, and myocardial velocities calculated using in-house software. Patients without proximal CTEPH (chronic thromboembolic PH) and not receiving intravenous prostacyclin therapy (n = 34) were followed up until the primary outcome of disease progression (death, transplantation, or progression to intravenous therapy) or the end of the study. Physicians who determined disease progression were blinded to CMR data. Conventional ventricular volumetric indices and novel TPM metrics were analyzed for prediction of 6-min walk distance (6MWD) and disease progression.

Results: Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers. Reversal of tangential E waves was observed in all patients and was highly discriminative for the presence of PH (p < 0.0001). The global radial E wave (β = 0.41, p = 0.017) and lateral wall radial systolic (S) wave velocities (β = 0.33, p = 0.028) were the only independent predictors of 6MWD in a model including RV ejection fraction (RVEF) and LV stroke volume. Over a median follow-up period of 20 months (IQR 7.9 months), 8 patients commenced intravenous therapy and 1 died. Global longitudinal E wave was the only independent predictor of clinical worsening (6.3× increased risk, p = 0.009) in a model including RVEF and septal curvature.

Conclusions: TPM metrics of LV diastolic function are significantly abnormal in PH. More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.

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Related in: MedlinePlus

Velocity color maps for a radial, b longitudinal, and c tangential segmental LV motion from a healthy volunteer (top) and a PH patient (bottom). The maps represent motion of sequential LV segments (y-axis) throughout the cardiac cycle (x-axis). The wave color (blue or red) indicates direction of motion, with color intensity representing relative magnitude of the segmental velocity. There are segmental E wave abnormalities in all components of motion: a Radially: In health, E wave timing is uniform throughout LV segments. In early diastole in PH, the anterior segment tends to move outwards (Erad wave) first whilst the septum continues to move inwards. b Longitudinally: In health, peak anterolateral segment Elong waves are of significantly greater magnitude, compared with only a trend for greater lateral segment Elong waves in PH. c Tangentially: Reversal of E1 and E2 waves was observed in all patients
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Fig3: Velocity color maps for a radial, b longitudinal, and c tangential segmental LV motion from a healthy volunteer (top) and a PH patient (bottom). The maps represent motion of sequential LV segments (y-axis) throughout the cardiac cycle (x-axis). The wave color (blue or red) indicates direction of motion, with color intensity representing relative magnitude of the segmental velocity. There are segmental E wave abnormalities in all components of motion: a Radially: In health, E wave timing is uniform throughout LV segments. In early diastole in PH, the anterior segment tends to move outwards (Erad wave) first whilst the septum continues to move inwards. b Longitudinally: In health, peak anterolateral segment Elong waves are of significantly greater magnitude, compared with only a trend for greater lateral segment Elong waves in PH. c Tangentially: Reversal of E1 and E2 waves was observed in all patients

Mentions: Figure 3a shows radial LV myocardial velocities as a function of position and time in a normal subject and a patient with PH. In patients, there was a trend towards Erad velocity peaking in the anterior segment first (approximately 80 ms, p = 0.026) as seen in Fig. 4. However, there was no significant regional difference in the magnitude of the Erad peaks (p > 0.07).Fig. 3


Left ventricular diastolic dysfunction in pulmonary hypertension predicts functional capacity and clinical worsening: a tissue phase mapping study.

Knight DS, Steeden JA, Moledina S, Jones A, Coghlan JG, Muthurangu V - J Cardiovasc Magn Reson (2015)

Velocity color maps for a radial, b longitudinal, and c tangential segmental LV motion from a healthy volunteer (top) and a PH patient (bottom). The maps represent motion of sequential LV segments (y-axis) throughout the cardiac cycle (x-axis). The wave color (blue or red) indicates direction of motion, with color intensity representing relative magnitude of the segmental velocity. There are segmental E wave abnormalities in all components of motion: a Radially: In health, E wave timing is uniform throughout LV segments. In early diastole in PH, the anterior segment tends to move outwards (Erad wave) first whilst the septum continues to move inwards. b Longitudinally: In health, peak anterolateral segment Elong waves are of significantly greater magnitude, compared with only a trend for greater lateral segment Elong waves in PH. c Tangentially: Reversal of E1 and E2 waves was observed in all patients
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696235&req=5

Fig3: Velocity color maps for a radial, b longitudinal, and c tangential segmental LV motion from a healthy volunteer (top) and a PH patient (bottom). The maps represent motion of sequential LV segments (y-axis) throughout the cardiac cycle (x-axis). The wave color (blue or red) indicates direction of motion, with color intensity representing relative magnitude of the segmental velocity. There are segmental E wave abnormalities in all components of motion: a Radially: In health, E wave timing is uniform throughout LV segments. In early diastole in PH, the anterior segment tends to move outwards (Erad wave) first whilst the septum continues to move inwards. b Longitudinally: In health, peak anterolateral segment Elong waves are of significantly greater magnitude, compared with only a trend for greater lateral segment Elong waves in PH. c Tangentially: Reversal of E1 and E2 waves was observed in all patients
Mentions: Figure 3a shows radial LV myocardial velocities as a function of position and time in a normal subject and a patient with PH. In patients, there was a trend towards Erad velocity peaking in the anterior segment first (approximately 80 ms, p = 0.026) as seen in Fig. 4. However, there was no significant regional difference in the magnitude of the Erad peaks (p > 0.07).Fig. 3

Bottom Line: Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers.TPM metrics of LV diastolic function are significantly abnormal in PH.More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.

View Article: PubMed Central - PubMed

Affiliation: Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK. danielknight@doctors.org.uk.

ABSTRACT

Background: The function of the right and left ventricles is intimately related through a shared septum and pericardium. Therefore, right ventricular (RV) disease in pulmonary hypertension (PH) can result in abnormal left ventricular (LV) myocardial mechanics. To assess this, we implemented novel cardiovascular magnetic resonance (CMR) tissue phase mapping (TPM) to assess radial, longitudinal and tangential LV myocardial velocities in patients with PH.

Methods: Respiratory self-gated TPM was performed using a rotating golden-angle spiral acquisition with retrospective cardiac gating. TPM of a mid ventricular slice was acquired in 40 PH patients and 20 age- and sex-matched healthy controls. Endocardial and epicardial LV borders were manually defined, and myocardial velocities calculated using in-house software. Patients without proximal CTEPH (chronic thromboembolic PH) and not receiving intravenous prostacyclin therapy (n = 34) were followed up until the primary outcome of disease progression (death, transplantation, or progression to intravenous therapy) or the end of the study. Physicians who determined disease progression were blinded to CMR data. Conventional ventricular volumetric indices and novel TPM metrics were analyzed for prediction of 6-min walk distance (6MWD) and disease progression.

Results: Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers. Reversal of tangential E waves was observed in all patients and was highly discriminative for the presence of PH (p < 0.0001). The global radial E wave (β = 0.41, p = 0.017) and lateral wall radial systolic (S) wave velocities (β = 0.33, p = 0.028) were the only independent predictors of 6MWD in a model including RV ejection fraction (RVEF) and LV stroke volume. Over a median follow-up period of 20 months (IQR 7.9 months), 8 patients commenced intravenous therapy and 1 died. Global longitudinal E wave was the only independent predictor of clinical worsening (6.3× increased risk, p = 0.009) in a model including RVEF and septal curvature.

Conclusions: TPM metrics of LV diastolic function are significantly abnormal in PH. More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.

Show MeSH
Related in: MedlinePlus