title: Pulmonary arterial hypertension: use of delayed contrast-enhanced cardiovascular magnetic resonance in risk assessment.
abstract: BACKGROUND
  Pulmonary arterial hypertension is a severe and progressive disease. Its early diagnosis is the greatest clinical challenge.
  
  
  OBJECTIVE
  To evaluate the presence and extension of the delayed myocardial contrast-enhanced cardiovascular magnetic resonance, as well as to verify if the percentage of the myocardial fibrosis mass is a severity predictor.
  
  
  METHODS
  Cross-sectional study with 30 patients with pulmonary arterial hypertension of groups I and IV, subjected to clinical, functional and hemodynamic evaluation, and to cardiac magnetic resonance.
  
  
  RESULTS
  The mean age of patients was 52 years old, with female predominance (77%). Among the patients, 53% had right ventricular failure at diagnosis, and 90% were in functional class II/III. The mean of the 6-minute walk test was 395 m. In hemodynamic study with right catheterism, the mean average pulmonary arterial pressure was 53.3 mmHg, of the cardiac index of 2.1 L/min.m(2), and median right atrial pressure was 13.5 mmHg. Delayed myocardial contrast-enhanced cardiovascular magnetic resonance was found in 28 patients. The mean fibrosis mass was 9.9 g and the median percentage of fibrosis mass was 6.17%. The presence of functional class IV, right ventricular failure at diagnosis, 6-minute walk test < 300 meters and right atrial pressure > 15 mmHg, with cardiac index < 2.0 L/min.m(2), there was a relevant association with the increased percentage of myocardial fibrosis.
  
  
  CONCLUSIONS
  The percentage of the myocardial fibrosis mass indicates a non-invasive marker with promising perspectives in identifying patients with high risk factors for pulmonary hypertension.
authors: Luiz Gustavo Pignataro
authors: LG
authors: Bessa
authors: Flávia Pegado
authors: FP
authors: Junqueira
authors: Marcelo Luiz da Silva
authors: ML
authors: Bandeira
authors: Marcelo Iorio
authors: MI
authors: Garcia
authors: Sérgio Salles
authors: SS
authors: Xavier
authors: Guilherme
authors: G
authors: Lavall
authors: Diego
authors: D
authors: Torres
authors: Daniel
authors: D
authors: Waetge
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005080:Exercise Test; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*
chemical_list: D003287:Contrast Media
references: Eur Respir J. 2007 Dec;30(6):1103-10
references: 17804449
references: N Engl J Med. 1996 Feb 1;334(5):296-301
references: 8532025
references: N Engl J Med. 2000 Nov 16;343(20):1445-53
references: 11078769
references: Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7
references: 12091180
references: Eur Heart J. 2003 Dec;24(23):2151-5
references: 14643276
references: Ann Intern Med. 1991 Sep 1;115(5):343-9
references: 1863023
references: J Am Coll Cardiol. 2004 Jan 7;43(1):27-34
references: 14715178
references: Circulation. 2006 Oct 24;114(17):1883-91
references: 17060398
references: J Magn Reson Imaging. 2003 Mar;17(3):323-9
references: 12594722
references: J Am Coll Cardiol. 2004 Jun 16;43(12 Suppl S):5S-12S
references: 15194173
references: Eur Heart J. 2007 May;28(10):1250-7
references: 17242010
references: AJR Am J Roentgenol. 2007 Feb;188(2):349-55
references: 17242241
references: Eur Heart J. 2004 Nov;25(21):1940-65
references: 15522474
references: Arq Bras Cardiol. 2004 Aug;83(2):118-24; 111-7
references: 15322654
references: J Am Coll Cardiol. 2002 Aug 21;40(4):780-8
references: 12204511
references: Am Heart J. 2004 Feb;147(2):218-23
references: 14760316
references: Br J Radiol. 2009 Oct;82(982):821-6
references: 19398466
references: Chest. 2004 Jul;126(1 Suppl):14S-34S
references: 15249493
references: Lancet. 2003 Feb 1;361(9355):374-9
references: 12573373
references: Circulation. 2003 Jul 8;108(1):54-9
references: 12821550
references: Circulation. 1999 Nov 9;100(19):1992-2002
references: 10556226
references: J Am Coll Cardiol. 2003 May 7;41(9):1568-72
references: 12742299
references: Chest. 2004 Jul;126(1 Suppl):78S-92S
references: 15249497
references: Circulation. 1989 Aug;80(2):353-60
references: 2752562
references: J Am Coll Cardiol. 2003 May 7;41(9):1561-7
references: 12742298
references: Eur Heart J. 2005 Oct;26(19):1993-9
references: 15899927
references: Chest. 2001 Jun;119(6):1761-5
references: 11399703