Contrast enhanced-cardiovascular MRI in patients with cor pulmonale

Objective: To determine the characteristics of contrast enhanced-cardiovascular magnetic resonance imaging (CE-CMRI) in patients with cor pulmonale. Methods: Twenty-one patients with cor pulmonale were prospectively included and underwent CMRI. Short-axis cine images of the heart were obtained for ventricular function assessment using a steady-state free precession sequence. For first-pass perfusion, a Turbo FLASH was performed after intravenous administration of 0.2 mmol/kg Gadopentetate dimeglumine. For delayed contrast enhancement (DCE), a short-axis phase-sensitive inversion recovery sequence was performed. Right ventricular function and myocardial contrasted volume in DCE were measured with Argus software. Spearman correlation analysis was conducted to examine the association between myocardial contrasted volume and right ventricular function. Results CMRI showed the enlarged right atrium and ventricle, bowing ventricular septum in 21 patients. Septal angle was (70 ± 11)°, Right ventricular end diastolic volume (RVEDV) and end systolic volume RVESV respectively were (205 ± 48) and (141 ± 33) ml, stroke volume(RVSV) was (64 ± 21) ml and ejection fraction RVEF was (32 ± 11)%. Average RV myocardial mass was (100 ± 37) g. No abnormal lesions were observed in the first-pass perfusion imaging. All patients showed triangular DCE in the insertion points (IP) of the right ventricular free wall to the interventricular septum and one in middle layer of interventricular septum. The DCE myocardial volume was (13 ± 3) ml. Spearman correlation showed DCE myocardial volume correlated with septal angle (r = 0.419, P = 0.033), RVESV (r = 0.598, P = 0.001), RVEF (r = -0.709, P = 0.001) and average RV myocardial mass(r = 0.441, P = 0.024). Conclusions: Negative first-pass perfusion and positive DCE are mainly present in patients with cor pulmonale. DCE is mainly present within the insertion points of the right ventricular free wall to the interventricular septum. DCE extent correlates with RV function. (authors)