Paradoxical Interventricular Septal Motion as a Major Determinant of Late Gadolinium Enhancement in Ventricular Insertion Points in Pulmonary HypertensionReportar como inadecuado




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Background

This study investigated the major clinical determinants of late gadolinium enhancement LGE at ventricular insertion points VIPs commonly seen in patients with pulmonary hypertension PH.

Methods

Forty-six consecutive PH patients mean pulmonary artery pressure ≥25 mmHg at rest and 21 matched controls were examined. Right ventricular RV morphology, function and LGE mass volume at VIPs were assessed by cardiac magnetic resonance CMR. Radial motion of the left ventricular LV wall and interventricular septum IVS was assessed by speckle-tracking echocardiography. Paradoxical IVS motion index was then calculated. Univariate and multivariate regression analysis were conducted to characterize the relationship between LGE volume at VIPs and PH-related clinical indices, including the paradoxical IVS motion index.

Results

Mean pulmonary arterial pressure MPAP of PH patients was 38±9 mmHg. LGE at VIPs was observed in 42 of 46 PH patients, and the LGE volume was 2.02 mL 0.47–2.99 mL. Significant correlations with LGE volume at VIPs were observed for MPAP r = 0.50 and CMR-derived parameters RV mass index r = 0.53, RV end-diastolic volume index r = 0.53, RV ejection fraction r = −0.56, and paradoxical IVS motion index r = 0.77. In multiple regression analysis, paradoxical IVS motion index alone significantly predicted LGE volume at VIPs p<0.001.

Conclusions

LGE at VIPs seen in patients with PH appears to reflect altered IVS motion rather than elevated RV pressure or remodeling. Long-term studies would be of benefit to characterize the clinical relevance of LGE at VIPs.



Autor: Takahiro Sato, Ichizo Tsujino , Hiroshi Ohira, Noriko Oyama-Manabe, Yoichi M. Ito, Teruo Noguchi, Asuka Yamada, Daisuke Ikeda, Ta

Fuente: http://plos.srce.hr/



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