Biventricular Dysfunction and Ventricular Interdependence in Patients With Pulmonary Hypertension: A 3.0‐T Cardiac MRI Feature Tracking Study

• Published in: Journal of magnetic resonance imaging Vol. 60; no. 1; pp. 350 - 362
• Main Authors: Fang, Han, Wang, Jin, Shi, Rui, Li, Yuan, Li, Xue‐Ming, Gao, Yue, Shen, Li‐Ting, Qian, Wen‐Lei, Jiang, Li, Yang, Zhi‐Gang
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2024; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; biventricular dysfunction; Correlation; Female; Field strength; Heart; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - physiopathology; Impairment; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Multivariable control; Population studies; Pulmonary arteries; Pulmonary artery; Pulmonary hypertension; Regression analysis; Retrospective Studies; Statistical analysis; Statistical tests; strain; Strain rate; Stroke Volume; Variance analysis; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; ventricular interdependence; strain; ventricular interdependence; pulmonary hypertension; biventricular dysfunction
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.29044

Background Pulmonary hypertension (PH) results in right ventricular (RV) dysfunction, subsequently leading to left ventricular (LV) impairment. The mechanism underlying ventricular interdependence is largely uninvestigated. Purpose To explore the biventricular dysfunction and the ventricular interdependence in PH patients. Study Type Retrospective. Population One hundred and seven PH patients (mean pulmonary artery pressure >20 mmHg) and 72 age‐ and sex‐matched controls with cardiac magnetic resonance imaging (MRI) studies. Field Strength/Sequence 3.0 T/balanced steady‐state free precession sequence. Assessment LV and RV ejection fractions (EF) and RV and LV radial, circumferential, and longitudinal strains were assessed using commercial software. Strains were compared between controls, PH patients with preserved RVEF (RVEF ≥40%, N = 48), and PH patients with reduced RVEF (RVEF <40%, N = 59). Statistical Tests Chi‐squared tests or Fisher's exact test, t tests or Mann–Whitney U test, one‐way ANOVA with Bonferroni's post hoc correction or Kruskal–Wallis test, Pearson or Spearman correlation, and multivariable linear regression analysis. A two‐tailed P < 0.05 was deemed statistically significant. Results RV strain decreased sequentially from controls, through PH with preserved RVEF, to PH with reduced RVEF. PH patients with reduced RVEF had significantly lower LV strain, especially septal strain, and LV peak diastolic strain rate compared with both controls and PH patients with preserved RVEF. Multivariable analyses showed that RVEF was independently correlated with LV strain; furthermore, independent of RVEF, RV strain was significantly correlated with LV strain (LVGRS: β = 0.416; LVGCS: β = −0.371; LVGLS: β = 0.283). Data Conclusion Subclinical impairment of RV function was found in PH with preserved RVEF. LV strain was impaired when RV was dysfunctional, which was associated with worsening RV strain. Therefore, while focusing on improving RV function, LV dysfunction in PH patients should also be monitored and treated early in order to slow the progression of the disease. Level of Evidence 3 Technical Efficacy Stage 3