Monda Lotfy Shehata MD, Presenter: Nothing to Disclose

Joao A.C. Lima MD, Abstract Co-Author: Grant, Toshiba Corporation Grant, Bracco Group Grant, Astellas Group

Nael F. Osman PhD, Abstract Co-Author: Founder, Diagnosoft Inc Shareholder, Diagnosoft Inc

David A. Bluemke MD, PhD, Abstract Co-Author: Nothing to Disclose

Paul M. Hassoun MD, Abstract Co-Author: Nothing to Disclose

Jens Vogel-Claussen MD, Abstract Co-Author: Research grant, Siemens AG

Myocardial scar is frequently associated with pulmonary hypertension (PH). The purpose of the study is to test the hypothesis that myocardial scar patterns identified in PH using delayed contrast enhancement (DE) MRI are associated with altered regional ventricular function.

37 patients (mean age = 61 ± 12 years) with suspected PH underwent right heart catheterization (RHC). 31 patients had PH (mean pulmonary artery pressure = 47 ± 14 mmHg). All patients underwent same-day cardiac MRI using DE inversion recovery, tagging and fast strain encoded imaging (SENC) techniques for quantification of scar burden as well as circumferential (ECC) and longitudinal (ELL) shortening at DE regions respectively. A control group of 10 age matched subjects was imaged using the same techniques for comparison. The mass (in grams) of myocardial DE was quantified at the anterior and posterior right ventricular (RV) septal insertions (ASI and PSI respectively) at the basal, mid and apical ventricular levels using dedicated software (Medis, the Netherlands). Similarly, ECC and ELL expressed as % shortening were quantified at the corresponding regions in tagged and SENC images using dedicated software (Diagnosoft, Palo, Alto). Correlation between DE, ECC and ELL was tested using Spearman’s rho correlation. Mann-Whitney test was used for inter group comparisons.

All PH patients but one demonstrated DE at the RV insertion points versus one non-PH subject (mean DE mass = 4.6g ±3.3 and 0.6g ±1.4 respectively, p< 0.001). ELL was significantly reduced at the ASI at all levels in PH patients compared to controls (p<0.05 for all) whereas ECC was significantly reduced at the PSI at the mid and apical levels only (p<0.05 for all). Reduced ELL at the ASI was significantly correlated with increased DE mass at all levels especially at the basal level (r = 0.6, p<0.001) whereas ECC was correlated best with DE mass at the mid ventricular level (r =0.5, p<0.001). PSI-DE mass showed no significant correlation with ECC and ELL.

Myocardial scar burden at the RV-ASI correlates with altered RV regional longitudinal shortening.

Increased myocardial scar burden at the anterior RV septal insertion indicates reduced focal longitudinal contraction in patients with pulmonary hypertension.

Shehata, M, Lima, J, Osman, N, Bluemke, D, Hassoun, P, Vogel-Claussen, J, Myocardial Scar in Patients with Pulmonary Hypertension: Relationship to Regional Function Evaluated by Cardiac MRI.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015385.html