title: Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension.
abstract: BACKGROUND
  Late gadolinium enhancement (LGE) occurs at the right ventricular (RV) insertion point (RVIP) in patients with pulmonary hypertension (PH) and has been shown to correlate with cardiovascular magnetic resonance (CMR) derived RV indices. However, the prognostic role of RVIP-LGE and other CMR-derived parameters of RV function are not well established. Our aim was to evaluate the predictive value of contrast-enhanced CMR in patients with PH.
  
  
  METHODS
  RV size, ejection fraction (RVEF), and the presence of RVIP-LGE were determined in 58 patients with PH referred for CMR. All patients underwent right heart catheterization, exercise testing, and N-terminal pro-brain natriuretic peptide (NT-proBNP) evaluation; results of which were included in the final analysis if performed within 4 months of the CMR study. Patients were followed for the primary endpoint of time to clinical worsening (death, decompensated right ventricular heart failure, initiation of prostacyclin, or lung transplantation).
  
  
  RESULTS
  Overall, 40/58 (69%) of patients had RVIP-LGE. Patients with RVIP- LGE had larger right ventricular volume index, lower RVEF, and higher mean pulmonary artery pressure (mPAP), all p < 0.05. During the follow-up period of 10.2 ± 6.3 months, 19 patients reached the primary endpoint. In a univariate analysis, RVIP-LGE was a predictor for adverse outcomes (p = 0.026). In a multivariate analysis, CMR-derived RVEF was an independent predictor of clinical worsening (p = 0.036) along with well-established prognostic parameters such as exercise capacity (p = 0.010) and mPAP (p = 0.001).
  
  
  CONCLUSIONS
  The presence of RVIP-LGE in patients with PH is a marker for more advanced disease and poor prognosis. In addition, this study reveals for the first time that CMR-derived RVEF is an independent non-invasive imaging predictor of adverse outcomes in this patient population.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Freed
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
authors.forename: Sonal
authors.initials: S
authors.lastname: Chandra
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.forename: Stuart
authors.initials: S
authors.lastname: Rich
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Archer
authors.forename: E Bruce
authors.initials: EB
authors.lastname: Jamison
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D002641:Chicago; D003287:Contrast Media; D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016278:Ventricular Function, Right
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D019786:Gadolinium DTPA