Cardiovascular magnetic resonance (CMR) images in a patient with idiopathic pulmonary arterial hypertension. (A) Cine image of 4-chamber view in end diastole showing an enlarged right ventricle (RV) and atrium (RA) and a small left ventricle (LV) and atrium (LA). The RV is hypertrophied, and pericardial effusion is present. (B) Cine short axis stack covering the heart from apex to the base is used for the volumetric assessment of ventricle (C) and atria (D). (C) Example of epicardial and endocardial delineations of both ventricles (in white) and (D) endocardial delineations of both atria. (E) RV and LV tracking for strain analysis in 4-chamber view. (F) Time resolved strain analysis curves for RV and LV (here global longitudinal strain (GLS)). (G) Atrio-ventricular plane in end diastole (red line) in 4-chamber view and (H) in end systole (blue line). Atrio-ventricular displacement (AVPD) is measured as the distance moving from base to apex between the red line in end diastole and the blue line in end systole. The longitudinal contribution to stroke volume (SV) is the volume encompassed by the atrio-ventricular plane marked with blue colour in the left ventricle and green colour in the right ventricle. (I) Phase-sensitive inversion recovery late gadolinium image of short-axis view showing RV insertion fibrosis (white arrows) and (J) increased native T1 values in the corresponding areas. (K) Anatomical view of the pulmonary artery delineated in white. (L) Phase-contrast imaging of the pulmonary artery delineated in white from which the flow is computed. (M) Time-resolved pulmonary flow curve during one cardiac cycle. Notice the systolic notch (black arrow), which is indicative of increased pulmonary vascular resistance [
111,
120,
121]. (N) 3D plot of pulmonary flow marking the velocity of each voxel from late systolic phase. Simultaneously with the systolic forward flow, backward flow (arrows) is present in the posterior part of the pulmonary artery. This patient had the following data:
Volumes and function—RV: end-diastolic volume 356 ml, end-systolic volume 284 ml, stroke volume 72 ml, ejection fraction 20%, mass 83 g; LV: end-diastolic volume 117 ml, end-systolic volume 72 ml, stroke volume 45 ml, ejection fraction 39%, mass 88 g; RA maximum volume 292 ml, LA maximum volume 51 ml.
Strain and regional function—peak LV GLS − 8.5%, peak RV free wall GLS − 9.2%, RV atrio-ventricular plane displacement 11.2 mm, RV longitudinal contribution to SV 64%, RV lateral contribution to SV 36%, LV atrio-ventricular plane displacement 7.5 mm, LV longitudinal contribution to SV 53%, LV lateral contribution to SV 43%, septal contribution to SV 5%.
Tissue characterization—T1 values 1420 ms (increased) at the RV insertion points and 1030 ms (normal) in the RV and LV.
Pulmonary artery—pulmonary net flow 66 ml, peak velocity 52 cm/s, mean velocity 17 cm/s, area 15.03 cm
2, distensibility 0.13%/mmHg