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Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension

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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

Key Points

• 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.

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Abbreviations

BPA:

balloon pulmonary angioplasty

CMR:

cardiac magnetic resonance

CO:

cardiac output

CTEPH:

chronic thromboembolic pulmonary hypertension

ECV:

extracellular volume fraction

EDD:

end-diastolic diameter

EDV:

end-diastolic volume

EF:

ejection fraction

EMB:

endomyocardial biopsy

ESD:

end-systolic diameter

ESV:

end-systolic volume

LGE:

late gadolinium enhancement

LV:

left ventricle

mPAP:

mean pulmonary arterial pressure

PA:

pulmonary artery

PAOP:

pulmonary arterial occlusion pressure

PEA:

pulmonary endarterectomy

PH:

pulmonary hypertension

PVR:

pulmonary vascular resistance

RAP:

right atrial pressure

RVIP:

right ventricular insertion point

PEA:

pulmonary endarterectomy

ROI:

region of interest

RV:

right ventricle

SD:

standard deviation

SV:

stroke volume

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Acknowledgments

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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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Justus-Liebig-University Giessen, Klinikstr. 33, 35392, Giessen, Germany

    Fritz C. Roller, Andreas Breithecker, Christian Schneider & Gabriele A. Krombach

  2. Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany

    Christoph Wiedenroth & Eckhard Mayer

  3. Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany

    Christoph Liebetrau, Andreas Rolf & Christian Hamm

  4. Department of Cardiology, Justus-Liebig-University Giessen, Giessen, Germany

    Christian Hamm

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  1. Fritz C. Roller
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Correspondence to Fritz C. Roller.

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Roller, F.C., Wiedenroth, C., Breithecker, A. et al. Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension. Eur Radiol 27, 1980–1991 (2017). https://doi.org/10.1007/s00330-016-4585-y

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  • DOI: https://doi.org/10.1007/s00330-016-4585-y

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