title: Association of Right Ventricular Pressure and Volume Overload with Non-Ischemic Septal Fibrosis on Cardiac Magnetic Resonance.
abstract: BACKGROUND
  Non-ischemic fibrosis (NIF) on cardiac magnetic resonance (CMR) has been linked to poor prognosis, but its association with adverse right ventricular (RV) remodeling is unknown. This study examined a broad cohort of patients with RV dysfunction, so as to identify relationships between NIF and RV remodeling indices, including RV pressure load, volume and wall stress.
  
  
  RESULTS
  The population comprised patients with RV dysfunction (EF<50%) undergoing CMR and transthoracic echo within a 14 day (5 ± 3) interval. Cardiac structure, function, and NIF were assessed on CMR. Pulmonary artery systolic pressure (PASP) was measured on echo. 118 patients with RV dysfunction were studied, among whom 47% had NIF. Patients with NIF had lower RVEF (34 ± 10 vs. 39 ± 9%; p = 0.01) but similar LVEF (40 ± 21 vs. 39 ± 18%; p = 0.7) and LV volumes (p = NS). RV wall stress was higher with NIF (17 ± 7 vs. 12 ± 6 kPa; p < 0.001) corresponding to increased RV end-systolic volume (143 ± 79 vs. 110 ± 36 ml; p = 0.006), myocardial mass (60 ± 21 vs. 53 ± 17 gm; p = 0.04), and PASP (52 ± 18 vs. 41 ± 18 mmHg; p = 0.001). NIF was associated with increased wall stress among subgroups with isolated RV (p = 0.005) and both RV and LV dysfunction (p = 0.003). In multivariable analysis, NIF was independently associated with RV volume (OR = 1.17 per 10 ml, [CI 1.04-1.32]; p = 0.01) and PASP (OR = 1.43 per 10 mmHg, [1.14-1.81]; p = 0.002) but not RV mass (OR = 0.91 per 10 gm, [0.69-1.20]; p = 0.5) [model χ2 = 21; p<0.001]. NIF prevalence was higher in relation to PA pressure and RV dilation and was > 6-fold more common in the highest, vs. the lowest, common tertile of PASP and RV size (p<0.001).
  
  
  CONCLUSIONS
  Among wall stress components, NIF was independently associated with RV chamber dilation and afterload, supporting the concept that NIF is linked to adverse RV chamber remodeling.
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.|Department of Radiology, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Chaitanya B
authors.initials: CB
authors.lastname: Medicherla
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Ma
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Attila
authors.initials: A
authors.lastname: Feher
authors.affiliation: Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States of America.
authors.forename: Nina
authors.initials: N
authors.lastname: Kukar
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Alexi
authors.initials: A
authors.lastname: Geevarghese
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Parag
authors.initials: P
authors.lastname: Goyal
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Horn
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.|Department of Radiology, Weill Cornell Medical College, New York, New York, United States of America.|Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States of America.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
mesh_terms: D001794:Blood Pressure; D004452:Echocardiography; D004719:Endomyocardial Fibrosis / Q000503:physiopathology*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology; D054088:Ventricular Septum / Q000503:physiopathology*