Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension
The aim of this study was to assess septal and right ventricular insertion point (RVIP) fibrosis in patients with chronic thromboembolic pulmonary hypertension (CTEPH) via native T1 mapping and extracellular volume fraction (ECV) determination and to analyze correlations with functional parameters.
Imaging was performed at 1.5 Tesla in 24 patients diagnosed with CTEPH and 24 controls. T1 values were measured within the septal myocardium, the upper and lower RVIP, and the lateral wall at basal short axis section.
The mean septal native T1 values were 1012.8 ms ± 50.5 in the CTEPH group and 956.9 ms ± 24.4 in controls (p < 0.001), upper RIVP 1050.8 ms ± 64.2 vs. 965.3 ms ± 37.1 (p < 0.001), and lower RVIP 1084.4 ms ± 93.1 vs. 959.8 ms ± 40.4 (p < 0.001). The corresponding mean ECV values were also significantly increased in the CTEPH group (p < 0.001). Native septal T1 showed a strong negative correlation with right ventricular ejection fraction (k = -0.92; p = 0.01).
We conclude that native T1 mapping and ECV assessment enable visualization and quantification of septal fibrosis in CTEPH patients. The results also correlate well with right ventricular ejection fraction. Therefore, these parameters might be useful for prognosis and as therapy-monitoring tool in the future.
• Septal native T1 and ECV values are significantly higher in CTEPH patients.
• Native T1 and ECV values are elevated even in absence of LGE.
• These techniques therefore enable an improved quantification of septal fibrosis in CTEPH.
• Native T1 values also correlate well with right ventricular EF and PA-pressure.
• Prognosis and therapy-monitoring might be assessable in the future with these parameters.
KeywordsMRI PH CTEPH T1 Mapping ECV
balloon pulmonary angioplasty
cardiac magnetic resonance
chronic thromboembolic pulmonary hypertension
extracellular volume fraction
late gadolinium enhancement
mean pulmonary arterial pressure
pulmonary arterial occlusion pressure
pulmonary vascular resistance
right atrial pressure
right ventricular insertion point
region of interest
The scientific guarantor of this publication is Prof. Dr. Gabriele A. Krombach. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.
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