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Extent of MRI Delayed Enhancement of Myocardial Mass Is Related to Right Ventricular Dysfunction in Pulmonary Artery Hypertension

¹ Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
² Present address: Department of Cardiology, Glenfield Hospital, Groby Rd., Leicester LE3 9QP, United Kingdom.
³ Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.
⁴ Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Steady-state free precession (true FISP) and delayed contrast-enhanced cardiac MR images in 34-year-old woman with pulmonary artery hypertension. RV = right ventricle, PA = pulmonary artery. See also Figure S1, short-axis image at mid-ventricular level (true FISP), in supplemental data online. End-diastolic true FISP images in four-chamber (A), right ventricle three-chamber (B), and short-axis midventricular level.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Steady-state free precession (true FISP) and delayed contrast-enhanced cardiac MR images in 34-year-old woman with pulmonary artery hypertension. RV = right ventricle, PA = pulmonary artery. See also Figure S1, short-axis image at mid-ventricular level (true FISP), in supplemental data online. End-diastolic true FISP images in four-chamber (A), right ventricle three-chamber (B), and short-axis midventricular level.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Steady-state free precession (true FISP) and delayed contrast-enhanced cardiac MR images in 34-year-old woman with pulmonary artery hypertension. RV = right ventricle, PA = pulmonary artery. See also Figure S1, short-axis image at mid-ventricular level (true FISP), in supplemental data online. End-diastolic true FISP images in four-chamber (A), right ventricle three-chamber (B), and short-axis midventricular level.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Steady-state free precession (true FISP) and delayed contrast-enhanced cardiac MR images in 34-year-old woman with pulmonary artery hypertension. RV = right ventricle, PA = pulmonary artery. See also Figure S1, short-axis image at mid-ventricular level (true FISP), in supplemental data online. Delayed contrast-enhanced image in identical position to C. Arrows indicate hyperenhanced areas at anterior and inferior insertion points of right ventricle to septum. Note also moderate pericardial effusion.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Short-axis and modified two-chamber delayed contrast-enhanced MR images of 42-year-old man with pulmonary artery hypertension. RV = right ventricle, LV = left ventricle. Inversion recovery gradient-echo (turbo FLASH) images show base of right ventricle (A), midventricular level (B), apex of right ventricle in short-axis plane (C), and modified two-chamber view (D). Arrows indicate hyperenhanced areas at anterior and inferior insertion points of right ventricle to interventricular insertion point in pulmonary artery hypertension.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Short-axis and modified two-chamber delayed contrast-enhanced MR images of 42-year-old man with pulmonary artery hypertension. RV = right ventricle, LV = left ventricle. Inversion recovery gradient-echo (turbo FLASH) images show base of right ventricle (A), midventricular level (B), apex of right ventricle in short-axis plane (C), and modified two-chamber view (D). Arrows indicate hyperenhanced areas at anterior and inferior insertion points of right ventricle to interventricular insertion point in pulmonary artery hypertension.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Short-axis and modified two-chamber delayed contrast-enhanced MR images of 42-year-old man with pulmonary artery hypertension. RV = right ventricle, LV = left ventricle. Inversion recovery gradient-echo (turbo FLASH) images show base of right ventricle (A), midventricular level (B), apex of right ventricle in short-axis plane (C), and modified two-chamber view (D). Arrows indicate hyperenhanced areas at anterior and inferior insertion points of right ventricle to interventricular insertion point in pulmonary artery hypertension.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Short-axis and modified two-chamber delayed contrast-enhanced MR images of 42-year-old man with pulmonary artery hypertension. RV = right ventricle, LV = left ventricle. Inversion recovery gradient-echo (turbo FLASH) images show base of right ventricle (A), midventricular level (B), apex of right ventricle in short-axis plane (C), and modified two-chamber view (D). Arrows indicate hyperenhanced areas at anterior and inferior insertion points of right ventricle to interventricular insertion point in pulmonary artery hypertension.

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Specimens from interventricular septum of 23-year-old woman show histology of interventricular septum and anterior right ventricular insertion point in pulmonary artery hypertension. Photomicrographs show anterior insertion points (A and B) and mid septum (C). Note fat (asterisk, B and C), extracellular expansion and edema (pound sign, A), and fibrosis (triangle, A and B), which appears purple. (A and C, H and E, x50; B, elasticavan Gieson stain, x100)

View larger version (183K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Specimens from interventricular septum of 23-year-old woman show histology of interventricular septum and anterior right ventricular insertion point in pulmonary artery hypertension. Photomicrographs show anterior insertion points (A and B) and mid septum (C). Note fat (asterisk, B and C), extracellular expansion and edema (pound sign, A), and fibrosis (triangle, A and B), which appears purple. (A and C, H and E, x50; B, elasticavan Gieson stain, x100)

View larger version (189K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Specimens from interventricular septum of 23-year-old woman show histology of interventricular septum and anterior right ventricular insertion point in pulmonary artery hypertension. Photomicrographs show anterior insertion points (A and B) and mid septum (C). Note fat (asterisk, B and C), extracellular expansion and edema (pound sign, A), and fibrosis (triangle, A and B), which appears purple. (A and C, H and E, x50; B, elasticavan Gieson stain, x100)

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