Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

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 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 Simpson9s method, and a ratio of basal-to-apical RVEF (RVEF ratio ) 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 ratio (median 1.4 vs 1.1; p ratio increased with increasing PH severity (p 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.