title: LGE patterns in pulmonary hypertension do not impact overall mortality.
abstract: OBJECTIVE
  The goal of this study was to determine the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) features in patients with pulmonary hypertension.
  
  
  BACKGROUND
  The prognostic significance of LGE in the clinical assessment of patients with pulmonary hypertension remains uncertain.
  
  
  METHODS
  Consecutive patients with suspected pulmonary hypertension seen at a specialist pulmonary hypertension referral center who underwent right heart catheterization and CMR with LGE imaging within 48 h were identified. Short-axis late-enhancement imaging was performed using a 3-dimensional gradient spoiled echocardiography sequence on a 1.5-T scanner. Three groups were identified: 1) no late enhancement of the myocardium; 2) late enhancement at the right ventricular insertion points (LGE-IP); and 3) late enhancement involving the right ventricular insertion points and the interventricular septum (LGE-S).
  
  
  RESULTS
  Of 194 patients, 162 had pulmonary hypertension. LGE was identified in 135 of 162 (83%) patients with pulmonary hypertension, and 47 (29%) of patients demonstrated LGE-S. Patients with LGE-S had significantly higher right ventricular end-diastolic volume index (p = 0.013) and lower mixed venous oxygen saturation (p = 0.045) than patients with LGE-IP alone. The presence of LGE-S (p = 0.022), but not LGE-IP alone, right ventricular end-systolic volume (p = 0.045), right ventricular ejection fraction (p = 0.034), mixed venous oxygen saturation (p = 0.021), mean right atrial pressure (0.027), and male sex (p = 0.002) predicted mortality. At multivariate analysis, male sex was the only significant predictor of mortality independent of covariate predictors (p = 0.027).
  
  
  CONCLUSIONS
  The presence of LGE at the right ventricular insertion points is suggestive of the presence of pulmonary hypertension. LGE may also be more extensive, involving the septum; however, after multivariable analysis including other factors associated with pulmonary hypertension, septal LGE was not associated with an increase in overall mortality.
authors.affiliation: Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom; INSIGNEO, Institute for In Silico Medicine, University of Sheffield, United Kingdom. Electronic address: a.j.swift@shef.ac.uk.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Swift
authors.affiliation: Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Smitha
authors.initials: S
authors.lastname: Rajaram
authors.affiliation: Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Dave
authors.initials: D
authors.lastname: Capener
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Charlie
authors.initials: C
authors.lastname: Elliot
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Robin
authors.initials: R
authors.lastname: Condliffe
authors.affiliation: Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Jim M
authors.initials: JM
authors.lastname: Wild
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: David G
authors.initials: DG
authors.lastname: Kiely
mesh_terms: D000328:Adult; D000368:Aged; D016280:Atrial Function, Right; D062185:Atrial Pressure; D006328:Cardiac Catheterization; D003287:Contrast Media; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D016278:Ventricular Function, Right
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: cardiac magnetic resonance; gadolinium; idiopathic pulmonary arterial hypertension; prognosis right ventricle; pulmonary hypertension