Pulmonary Arterial Hypertension: Use of Delayed Contrast-Enhanced Cardiovascular Magnetic Resonance in Risk Assessment

Background

Pulmonary arterial hypertension is a severe and progressive disease. Itsearly diagnosis is the greatest clinical challenge.

Objective

To evaluate the presence and extension of the delayed myocardialcontrast-enhanced cardiovascular magnetic resonance, as well as to verify ifthe percentage of the myocardial fibrosis mass is a severity predictor.

Methods

Cross-sectional study with 30 patients with pulmonary arterial hypertensionof groups I and IV, subjected to clinical, functional and hemodynamicevaluation, and to cardiac magnetic resonance.

Results

The mean age of patients was 52 years old, with female predominance (77%).Among the patients, 53% had right ventricular failure at diagnosis, and 90%were in functional class II/III. The mean of the 6-minute walk test was395m. In hemodynamic study with right catheterism, the mean averagepulmonary arterial pressure was 53.3mmHg, of the cardiac index of 2.1L/min.m², and median right atrial pressure was 13.5 mmHg.Delayed myocardial contrast enhanced cardiovascular magnetic resonance wasfound in 28 patients. The mean fibrosis mass was 9.9 g and the medianpercentage of fibrosis mass was 6.17%. The presence of functional class IV,right ventricular failure at diagnosis, 6-minute walk test < 300 metersand right atrial pressure ≥ 15 mmHg, with cardiac index < 2.0 L/min.m², there was a relevant association with the increasedpercentage of myocardial fibrosis.

Conclusion

The percentage of the myocardial fibrosis mass indicates a non-invasivemarker with promising perspectives in identifying patients with high riskfactors for pulmonary hypertension.