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Prevalence and Correlates of Septal Delayed Contrast Enhancement in Patients With Pulmonary Hypertension

https://doi.org/10.1016/j.amjcard.2007.03.094Get rights and content

Using cardiac magnetic resonance, the presence of myocardial delayed contrast enhancement (DCE) has been described in the ventricular septum at the level of the right ventricular insertion points in patients with pulmonary hypertension (PH). The aim of this study was to investigate the prevalence, extent, and correlates of this finding. Septal DCE was evaluated in 55 patients with known or suspected PH of various causes. The extent of DCE was estimated visually with an insertion enhancement score (range 0 to 4) and quantified as DCE mass. The results were correlated with cine magnetic resonance and right-sided cardiac catheterization. Predictors of DCE were investigated using multivariate analysis. PH at rest was present in 42 patients (group 1) and absent in 13 (group 2). DCE was noted in 41 patients (97%) in group 1 and 3 (23%) in group 2 (p <0.0001). The extent of DCE was higher in group 1 than group 2 (median insertion enhancement score 3 vs 0, median DCE mass 8.7 vs 0 g, respectively; p <0.0001 for both). The extent of DCE showed moderate to good univariate correlations (r = 0.5 to 0.73) with pulmonary pressures and with right ventricular volumes, mass, and ejection fractions. In multivariate analysis, systolic pulmonary pressure was the only predictor of DCE. In conclusion, the presence of septal DCE at the right ventricular insertion points is common in PH of different causes, and the level of systolic pulmonary pressure elevation appears to be the main determinant of this finding.

Section snippets

Methods

The study population consisted of 72 patients referred for cardiac magnetic resonance evaluation of known or suspected PH (September 2004 to March 2006) who additionally underwent right-sided cardiac catheterization. All patients gave informed consent for the procedures, and the study was approved by the institutional review board. Criteria of exclusion from the analysis were time interval between magnetic resonance and catheterization >3 months and DCE in areas other than the septal RV

Results

After the exclusion of 10 patients with time intervals between cardiac magnetic resonance and catheterization >3 months, 5 patients with DCE in other areas (4 with previous myocardial infarctions and 1 with diffuse cardiac sarcoidosis), and 2 patients who refused to receive contrast agents, the final study population consisted of 55 patients. They were predominantly women (33 [60%]), with a mean age of 50 years (range 29 to 88). The median time interval between examinations was 0 days (mean

Discussion

The main findings of this investigation are as follows: (1) DCE in the septum at the level of the RV insertion points is extremely common in patients with chronic PH of different causes; (2) the extent of DCE correlates with the degree of hemodynamic and RV morphofunctional impairment; and (3) in multivariate analysis, systolic pulmonary pressure is the only predictor of DCE.

In this study, the prevalence of DCE was very high in patients with confirmed PH at rest. There were also 2 subjects with

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Conflict of interest: Dr. O’Donnell is an employee of Siemens Corporate Research, Princeton, New Jersey.

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