The study aim to assess right atrial (RA) remodeling, in terms of RA fibrosis, in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension patients. This will be investigated in detail with in-depth cardiac magnet resonance imaging (CMRI). A cohort with exclusion of pulmonary hypertension which underwent CMRI due to dyspnoe of unkown reason will be the control group.
Right atrial (RA) function consists of a reservoir, conduit, and active contractile function and can serve as a tool for the evaluation of the severity of RV dysfunction and prognosis in pulmonary hypertension according to recent data. In-depth evaluation of phasic RA function was previously undertaken either by echocardiographic speckle tracking or by cardiac magnetic resonance (CMR) imaging-derived feature tracking. However, it is currently unknown if right atrial remodeling is present. As described for left atrial fibrosis, the presence and extent of atrial fibrosis can be quantified using CMR late gadolinium enhancement. The protocol for the assessment of left atrial fibrosis will be used and adapted to the RA. Patients will undergo 3-dimensional late gadolinium enhancement CMRI along with a contrast-enhanced magnetic resonance angiography and cine imaging in order to define the anatomy of the RA and the superior and inferior vein. High-resolution late gadolinium enhancement images of the RA will be acquired 15 to 30 min after gadolinium-based contrast agents administration using a 3-dimensional inversion-recovery prepared, respiration navigated, and electrocardiogram triggered gradient-echo pulse sequence with fat saturation. Following acquisition of the scans, the endocardial borders of the RA will be defined in each slice by manual tracing. After manual adjustment of the epicardial RA surface, the quantification of fibrosis based on the relative intensity (signal intensity) of late gadolinium enhancement will be performed. Finally, a 3-dimensional model of the RA will be rendered with the maximum enhancement intensities being projected on the model surface.
Study Type
OBSERVATIONAL
Enrollment
40
right atrial late gadolinium enhancement in % and cm2
Kerckhoff-Klinik
Bad Nauheim, Hesse, Germany
University of Giessen
Giessen, Hesse, Germany
atrial fibrosis
right atrial late gadolinium enhancement in % and cm2
Time frame: 1 day
Correlation of right atrial fibrosis with functional and exercise capacity
right atrial late gadolinium enhancement in % and cm2 correlated with 6minute walking distance in m or peak oxygen uptake in ml/min/kg
Time frame: 1 day
Correlation of right atrial fibrosis with remodeling of the right atrium, backflow and systemic congestion
right atrial late gadolinium enhancement in % and cm2 correlated with right atrial size (volume and cm2) and inferior vena cava diameter in cm2
Time frame: 1 day
Correlation of right atrial fibrosis with pulmonary hemodynamics
right atrial late gadolinium enhancement in % and cm2 correlated with mean right atrial pressure
Time frame: 1 day
Correlation of right atrial fibrosis with load-independent right ventricular function assessed by pressure-volume loop catheterization
right atrial late gadolinium enhancement in % and cm2 correlated with end-systolic to arterial elastance
Time frame: 1 day
Correlation of right atrial fibrosis with biomarkers
right atrial late gadolinium enhancement in % and cm2 correlated with B-type natriuretic peptide in pg/ml
Time frame: 1 day
Prognostic relevance of right atrial fibrosis
right atrial late gadolinium enhancement in % and cm2 as a predictor of clinical worsening or death
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Time frame: 1 day