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Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance
  1. Leticia Fernandez-Friera1,2,3,
  2. Ana Garcia-Alvarez1,2,4,
  3. Gabriela Guzman1,2,
  4. Fatemeh Bagheriannejad-Esfahani1,
  5. Waqas Malick1,
  6. Ajith Nair1,
  7. Valentin Fuster1,2,
  8. Mario J Garcia1,
  9. Javier Sanz1
  1. 1The Zena and Michael A Wiener Cardiovascular Institute and Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, USA
  2. 2Fundacion Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
  3. 3Cardiology Department, Hospital Universitario Marques de Valdecilla–Instituto de Investigación y Formación Marques de Valdecilla (IFIMAV), Santander, Spain
  4. 4Cardiology Department, Thorax Institute, Hospital Clinic, Barcelona, Spain
  1. Correspondence to Javier Sanz, Cardiovascular Institute, Mount Sinai Hospital, 1 Gustave L Levy Place, Box 1030, New York, NY 10029, USA; javier.sanz{at}


Objective To evaluate segmental right ventricular (RV) dysfunction in pulmonary hypertension (PH) using cardiac magnetic resonance (CMR).

Design Cross-sectional analysis in a retrospective cohort of consecutive adult patients.

Setting Mount Sinai Hospital in New York.

Patients 192 patients with known or suspected PH undergoing right heart catheterisation and CMR. PH was defined as mean pulmonary artery pressure ≥25 mm Hg. Abnormal RV ejection fraction (RVEF) was defined as <50%. Patients were classified into: group 1 (no PH, normal RVEF; n=40), group 2 (PH, normal RVEF; n=41) or group 3 (PH, abnormal RVEF; n=111).

Interventions CMR and right heart catheterisation within a 2-week interval.

Main outcome measures On cine CMR images, the stack of RV short-axis views was divided into two equal halves. Basal and apical RVEF were calculated using Simpson's method, and a ratio of basal-to-apical RVEF (RVEFratio) was derived.

Results Basal RVEF did not differ between groups 1 and 2 (63±8% vs 64±8%; p=1); however, patients in group 2 had significantly lower apical RVEF (46±13% vs 58±10%; p<0.01) and higher RVEFratio (median 1.4 vs 1.1; p<0.01). Both apical and basal RVEF were reduced in group 3 compared with groups 1 and 2 (p<0.01), and the RVEFratio increased with increasing PH severity (p<0.01 for trend). An apical RVEF <50% was more sensitive than global RV dysfunction for the detection of PH.

Conclusions Apical dysfunction appears to occur before global RVEF decreases in chronic PH, potentially constituting an early and sensitive marker of RV dysfunction in this setting.

  • Pulmonary hypertension
  • right ventricular function
  • cardiac magnetic resonance
  • MRI
  • pulmonary arterial hypertension (PAH)

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  • Funding This work was partially supported by the Instituto de Formacion e Investigacion ‘Marques de Valdecilla’ (IFIMAV), Santander, Spain (PostMIR Wenceslao Lopez Albo grant to LF-F), the Spanish Society of Cardiology (postresidency grant to LF-F and AG-A) and CNIC Institution (AG-A).

  • Competing interests JS has served as a consultant for GE Healthcare. MJG has served as a consultant for BG Medicine, TheHeart.Org, MD Imaging.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Mount Sinai Hospital. Approval number HSD09-00355.

  • Provenance and peer review Not commissioned; externally peer reviewed.