title: Paradoxical interventricular septal motion as a major determinant of late gadolinium enhancement in ventricular insertion points in pulmonary hypertension.
abstract: BACKGROUND
  This study investigated the major clinical determinants of late gadolinium enhancement (LGE) at ventricular insertion points (VIPs) commonly seen in patients with pulmonary hypertension (PH).
  
  
  METHODS
  Forty-six consecutive PH patients (mean pulmonary artery pressure ≥25 mmHg at rest) and 21 matched controls were examined. Right ventricular (RV) morphology, function and LGE mass volume at VIPs were assessed by cardiac magnetic resonance (CMR). Radial motion of the left ventricular (LV) wall and interventricular septum (IVS) was assessed by speckle-tracking echocardiography. Paradoxical IVS motion index was then calculated. Univariate and multivariate regression analysis were conducted to characterize the relationship between LGE volume at VIPs and PH-related clinical indices, including the paradoxical IVS motion index.
  
  
  RESULTS
  Mean pulmonary arterial pressure (MPAP) of PH patients was 38±9 mmHg. LGE at VIPs was observed in 42 of 46 PH patients, and the LGE volume was 2.02 mL (0.47-2.99 mL). Significant correlations with LGE volume at VIPs were observed for MPAP (r = 0.50) and CMR-derived parameters [RV mass index (r = 0.53), RV end-diastolic volume index (r = 0.53), RV ejection fraction (r = -0.56), and paradoxical IVS motion index (r = 0.77)]. In multiple regression analysis, paradoxical IVS motion index alone significantly predicted LGE volume at VIPs (p<0.001).
  
  
  CONCLUSIONS
  LGE at VIPs seen in patients with PH appears to reflect altered IVS motion rather than elevated RV pressure or remodeling. Long-term studies would be of benefit to characterize the clinical relevance of LGE at VIPs.
authors.affiliation: First Department of Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sato
authors.forename: Ichizo
authors.initials: I
authors.lastname: Tsujino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohira
authors.forename: Noriko
authors.initials: N
authors.lastname: Oyama-Manabe
authors.forename: Yoichi M
authors.initials: YM
authors.lastname: Ito
authors.forename: Teruo
authors.initials: T
authors.lastname: Noguchi
authors.forename: Asuka
authors.initials: A
authors.lastname: Yamada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ikeda
authors.forename: Taku
authors.initials: T
authors.lastname: Watanabe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nishimura
mesh_terms: D016022:Case-Control Studies; D004452:Echocardiography; D005682:Gadolinium; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D054088:Ventricular Septum / Q000503:physiopathology*
chemical_list: D005682:Gadolinium