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Abstract
Background: Prior studies have showed that adverse right ventricular (RV) remodeling has significant prognostic implications to patients with precapillary pulmonary hypertension (PH), However, the determinants of RV structural and functional changes in PH are still not fully understood. Purpose: To characterize remodeling of the RV by CMR in patients with pre-capillary PH (either group 1or group 4 PH) and to correlate these changes with pulmonary hemodynamics, pulmonary artery (PA) stiffness and serum level of NT-proBNP. Methods: Forty-one patients with pre-capillary PH; 23 patients had idiopathic pulmonary arterial hypertension (IPAH) and 18 patients had chronic thromboembolic pulmonary hypertension (CTEPH). Six-minute walk distance (6MWD) were determined for all patients. Right heart catheterization and cardiac magnetic resonance (CMR) were performed for all patients in the same 24 hours. Right ventricular endsystolic (RVES) wall stress, PA stiffness indices and ventriculo-arterial(V-A) coupling (Emax/Ea) were determined by combining RHC and CMR data. Results: Thirty-four (83%) had (functional class) FC III symptoms and 7 patients (17%) had FC IV symptoms. Pulmonary vascular resistance index (PVRI) was the only independent determinant of RV ejection fraction(RVEF) (r= -0.42, p=0.006), Emax/Ea (r=-0.520, p=0.001) and RV free wall peak longitudinal systolic strain (r= -0.343, p=0.028). RV insertion points (RVIP) fibrosis was not correlated with any of hemodynamic data. Levels of NT-Pro BNP were significantly correlated with RAP and all RV volumes and function. No significant correlation could be found between PA pressures, PVRI and cardiac index(CI) with NT-Pro BNP levels