The overall goal of this study is to evaluate agreement between cardiac MR parameters and
well-established clinical and catheterization parameters of poor prognosis in patients with
pulmonary hypertension. The identification of noninvasive cardiac MR techniques to evaluate
myocardial disease in patients with pulmonary hypertension would be beneficial to society
due to the potential to replace serial invasive cardiac catheterization procedures with a
noninvasive imaging test.
1 BACKGROUND Currently the gold standard for evaluation of pulmonary hypertension is right
heart pressure as measured by cardiac catheterization. Thus the method for stratifying
patients with pulmonary hypertension in terms of risk and response to treatment is
suboptimal, requiring multiple invasive procedures.
A number of studies have suggested that cardiac MR imaging is useful in the diagnosis of
myocardial disease and may be related to patient prognosis in both ischemic and non-ischemic
cardiomyopathy. Patients with pulmonary hypertension demonstrate post gadolinium delayed
enhancement at the points of insertion of the right ventricle onto the inter-ventricular
septum, and the presence of this finding has been shown to be inversely correlated with
right ventricular function.
Quantitative evaluation of extracellular volume by post-gadolinium T1 relaxation time
mapping (T1 mapping) and extracellular volume (ECV) mapping is used to quantify the extent
of myocardial fibrosis, can detect fibrosis earlier than delayed enhancement imaging, and is
particularly useful in non-ischemic or diffuse myocardial diseases. In addition,
Displacement Encoding with Stimulated Echoes (DENSE) is a technique that allows
quantification of tissue motion and myocardial strain, which can identify early myocardial
dysfunction in patients with preserved ejection fraction, and therefore may be useful in the
evaluation of myocardial function in pulmonary hypertension.
Utilization of novel cardiac MR techniques for quantitative assessment of the extent of
subclinical myocardial disease in patients with pulmonary hypertension may therefore serve
as a non-invasive tool to inform prognosis and surrogate biomarker to evaluate effectiveness
of treatment strategies, with the potential to replace serial cardiac catheterization in
Our hypothesis is that utilization of novel cardiac MR techniques for quantitative
assessment of the extent of subclinical myocardial disease in patients with pulmonary
hypertension may serve as a non-invasive tool to inform prognosis and surrogate biomarker to
evaluate effectiveness of treatment strategies, with the potential to replace serial cardiac
catheterization in these patients.
Adult patients with pulmonary hypertension under clinical care at the UCSF pulmonary
hypertension clinic who are referred for right heart catheterization will be invited to
participate in our study. Screening data will be reviewed to determine subject eligibility.
Subjects who meet all inclusion criteria and none of the exclusion criteria will be entered
into the study. Each participant will undergo cardiac MR examination during a single
one-hour study visit.
- Pulmonary hypertension
- Renal dysfunction
- Cochlear implant
- Previous lung transplant