Left ventricular ischemia in pre-capillary pulmonary hypertension: a cardiovascular magnetic resonance study
| Autor: | Rajiv Ananthakrishna, David S. Celermajer, Jennifer G Walker, Carmine G. De Pasquale, Angela Walls, Ranjit Shah, Susanna Proudman, Karthigesh Sree Raman, Richard J. Woodman, Joseph B. Selvanayagam, P. Steele, Michael B. Stokes |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Ischemia Vasodilation Magnetic resonance imaging 030204 cardiovascular system & hematology medicine.disease Pulmonary hypertension 030218 nuclear medicine & medical imaging Coronary arteries Coronary artery disease 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Internal medicine Right heart Cardiology Magnetic resonance study Medicine Original Article Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiovasc Diagn Ther |
| ISSN: | 2223-3660 2223-3652 |
| DOI: | 10.21037/cdt-20-698 |
| Popis: | Background Prognosis in pulmonary arterial hypertension (PAH) is largely dependent on right ventricular (RV) function. However, recent studies have suggested the presence of left ventricular (LV) dysfunction in PAH patients. The potential role of LV ischemia, as a contributor to progressive LV dysfunction, has not been systematically studied in PAH. We aim to assess the presence and extent of LV myocardial ischemia in patients with known PH and without obstructive coronary artery disease (CAD), using oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) and stress/rest CMR T1 mapping. Methods We prospectively recruited 28 patients with right heart catheter-proven PH and no significant CAD, 8 patients with known CAD and 11 normal age-matched controls (NC). OS-CMR images were acquired using a T2* sequence and T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at rest and adenosine-induced stress vasodilatation; ΔOS-CMR signal intensity (SI) index (stress/rest SI) and ΔT1 reactivity (stress-rest/rest T1 mapping) were calculated. Results Global LV ΔOS SI index was significantly lower in PH patients compared with controls (11.1%±6.7% vs. 20.5%±10.5%, P=0.016), as was ΔT1 reactivity (5.2%±4.5% vs. 8.0%±2.9%, P=0.047). The ischemic segments of CAD patients had comparable ΔOS SI (10.3%±6.4% vs. 11.1%±6.7%, P=0.773) to PH patients, but lower ΔT1 reactivity (1.1%±4.2% vs. 5.2%±4.5%, P=0.036). Conclusions Decreased OS-CMR SI and T1 reactivity signify the presence of impaired myocardial oxygenation and vasodilatory response in PH patients. Given their unobstructed epicardial coronary arteries, this is likely secondary to coronary microvascular dysfunction (CMD). |
| Databáze: | OpenAIRE |
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