Left Ventricular Fibrosis Assessment by Native T1, ECV, and LGE in Pulmonary Hypertension Patients

Cardiac magnetic resonance imaging (MRI) is emerging as an alternative to right heart catheterization for the evaluation of pulmonary hypertension (PH) patients. The aim of this study was to compare cardiac MRI-derived left ventricle fibrosis indices between pre-capillary PH (PrePH) and isolated post-capillary PH (IpcPH) patients and assess their associations with measures of ventricle function. Global and segmental late gadolinium enhancement (LGE), longitudinal relaxation time (native T1) maps, and extracellular volume fraction (ECV) were compared among healthy controls (N = 25; 37% female; 52 +/- 13 years), PH patients (N = 48; 60% female; 60 +/- 14 years), and PH subgroups (PrePH: N = 29; 65% female; 55 +/- 12 years, IpcPH: N = 19; 53% female; 66 +/- 13 years). Cardiac cine measured ejection fraction, end diastolic, and end systolic volumes and were assessed for correlations with fibrosis. LGE mural location was qualitatively assessed on a segmental basis for all subjects. PrePH patients had elevated (apical-, mid-antero-, and mid-infero) septal left ventricle native T1 values (1080 +/- 74 ms, 1077 +/- 39 ms, and 1082 +/- 47 ms) compared to IpcPH patients (1028 +/- 53 ms, 1046 +/- 36 ms, 1051 +/- 44 ms) (p < 0.05). PrePH had a higher amount of insertional point LGE (69%) and LGE patterns characteristic of non-vascular fibrosis (77%) compared to IpcPH (37% and 46%, respectively) (p < 0.05; p < 0.05). Assessment of global LGE, native T1, and ECV burdens did not show a statistically significant difference between PrePH (1.9 +/- 2.7%, 1056.2 +/- 36.3 ms, 31.2 +/- 3.7%) and IpcPH (2.7 +/- 2.7%, 1042.4 +/- 28.1 ms, 30.7 +/- 4.7%) (p = 0.102; p = 0.229 p = 0.756). Global native T1 and ECV were higher in patients (1050.9 +/- 33.8 and 31.0 +/- 4.1%) than controls (28.2 +/- 3.7% and 1012.9 +/- 29.4 ms) (p < 0.05). Cardiac MRI-based tissue characterization may augment understanding of cardiac involvement and become a tool to facilitate PH patient classification.