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Type: Journal article
Title: Right ventricular myocardial deoxygenation in patients with pulmonary artery hypertension
Author: Sree Raman, K.
Shah, R.
Stokes, M.
Walls, A.
Woodman, R.J.
Perry, R.
Walker, J.G.
Proudman, S.
De Pasquale, C.G.
Celermajer, D.S.
Selvanayagam, J.B.
Citation: Journal of Cardiovascular Magnetic Resonance, 2021; 23(1):22-1-22-11
Publisher: Springer Nature
Issue Date: 2021
ISSN: 1097-6647
Statement of
Karthigesh Sree Raman, Ranjit Shah, Michael Stokes, Angela Walls, Richard J. Woodman, Rebecca Perry, Jennifer G. Walker, Susanna Proudman, Carmine G. De Pasquale, David S. Celermajer, and Joseph B. Selvanayagam
Abstract: Background: In pulmonary arterial hypertension (PAH), progressive right ventricular (RV) dysfunction is believed to be largely secondary to RV ischaemia. A recent pilot study has demonstrated the feasibility of Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) to detect in-vivo RV myocardial oxygenation. The aims of the present study therefore, were to assess the prevalence of RV myocardial ischaemia and relationship with RV myocardial interstitial changes in PAH patients with non-obstructive coronaries, and corelate with functional and haemodynamic parameters. Methods: We prospectively recruited 42 patients with right heart catheter (RHC) proven PAH and 11 healthy age matched controls. The CMR examination involved standard functional imaging, OS-CMR imaging and native T1 mapping. An ΔOS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments. T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at the inferior RV segment. Results: The inferior RV ΔOS-CMR SI index was significantly lower in PAH patients compared with healthy controls (9.5 (– 7.4–42.8) vs 12.5 (9–24.6)%, p = 0.02). The inferior RV ΔOS-CMR SI had a significant correlation to RV inferior wall thickness (r = – 0.7, p < 0.001) and RHC mean pulmonary artery pressure (mPAP) (r = – 0.4, p = 0.02). Compared to healthy controls, patients with PAH had higher native T1 in the inferior RV wall: 1303 (1107–1612) vs 1232 (1159–1288) ms, p = 0.049. In addition, there was a significant difference in the inferior RV T1 values between the idiopathic PAH and systemic sclerosis associated PAH patients: 1242 (1107–1612) vs 1386 (1219–1552)ms, p = 0.007. Conclusion: Blunted OS-CMR SI suggests the presence of in-vivo microvascular RV dysfunction in PAH patients. The native T1 in the inferior RV segments is significantly increased in the PAH patients, particularly among the systemic sclerosis associated PAH group.
Keywords: Pulmonary artery hypertension; right ventricle; cardiac magnetic resonance (CMR); coronary microvascular dysfunction; oxygen-sensitive cardiac magnetic resonance; T1 mapping
Rights: © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
DOI: 10.1186/s12968-020-00694-0
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