title: Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance.
abstract: OBJECTIVE
  To evaluate segmental right ventricular (RV) dysfunction in pulmonary hypertension (PH) using cardiac magnetic resonance (CMR).
  
  
  METHODS
  Cross-sectional analysis in a retrospective cohort of consecutive adult patients.
  
  
  METHODS
  Mount Sinai Hospital in New York.
  
  
  METHODS
  192 patients with known or suspected PH undergoing right heart catheterisation and CMR. PH was defined as mean pulmonary artery pressure ≥ 25 mm Hg. Abnormal RV ejection fraction (RVEF) was defined as <50%. Patients were classified into: group 1 (no PH, normal RVEF; n = 40), group 2 (PH, normal RVEF; n = 41) or group 3 (PH, abnormal RVEF; n=111).
  
  
  METHODS
  CMR and right heart catheterisation within a 2-week interval. Main outcome measures On cine CMR images, the stack of RV short-axis views was divided into two equal halves. Basal and apical RVEF were calculated using Simpson's method, and a ratio of basal-to-apical RVEF (RVEF(ratio)) was derived.
  
  
  RESULTS
  Basal RVEF did not differ between groups 1 and 2 (63 ± 8% vs 64 ± 8%; p = 1); however, patients in group 2 had significantly lower apical RVEF (46 ± 13% vs 58 ± 10%; p<0.01) and higher RVEF(ratio) (median 1.4 vs 1.1; p<0.01). Both apical and basal RVEF were reduced in group 3 compared with groups 1 and 2 (p<0.01), and the RVEF(ratio) increased with increasing PH severity (p<0.01 for trend). An apical RVEF <50% was more sensitive than global RV dysfunction for the detection of PH.
  
  
  CONCLUSIONS
  Apical dysfunction appears to occur before global RVEF decreases in chronic PH, potentially constituting an early and sensitive marker of RV dysfunction in this setting.
authors.affiliation: The Zena and Michael A Wiener Cardiovascular Institute and Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, USA.
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernandez-Friera
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia-Alvarez
authors.forename: Gabriela
authors.initials: G
authors.lastname: Guzman
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Bagheriannejad-Esfahani
authors.forename: Waqas
authors.initials: W
authors.lastname: Malick
authors.forename: Ajith
authors.initials: A
authors.lastname: Nair
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
mesh_terms: D006328:Cardiac Catheterization; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology