Patients with Pulmonary Fibrosis: Cardiac Function Assessed with MR Imaging

PURPOSE: To detect abnormalities in cardiac function by using magnetic resonance (MR) imaging in patients with mild to moderate pulmonary fibrosis and to evaluate the relationship between pulmonary function and cardiac function.

MATERIALS AND METHODS: Sixteen patients were compared with 16 sex- and age-matched healthy control subjects. Systolic function was assessed by using multisection multiphase cine MR imaging. Diastolic function was assessed with flow-sensitive MR imaging across the mitral and tricuspid valves. MR imaging results were compared with the severity of impairment in pulmonary function.

RESULTS: Biventricular systolic function and left ventricular diastolic function were normal in patients, but right ventricular diastolic function was significantly impaired versus that of control subjects, witha ratio of peak flow during early diastolic (E) filling to peak flow during atrial contraction (A) of 0.85 ± 0.40 versus 1.28 ± 0.50 (P = .035). Biventricular E/A ratios were strongly correlated to age in patients and control subjects. The right ventricular E/A ratio in patients corresponded with values that are normally expected in people 20 years older. Diastolic left and right ventricular functions were significantly correlated with each other. There was no relationship between pulmonary function and cardiac function.

CONCLUSION: Impairment of right ventricular diastolic function was found by using MR imaging in patients with mild to moderate pulmonary fibrosis, whereas left ventricular diastolic function and biventricular systolic function were preserved.

References

  • 1 Oka M, Raaskakka T. Cardiac involvement in polymyositis. Scand J Rheumatol 1978; 7:203-208.
  • 2 Lee P, Langevitz P, Alderdice CA, et al. Mortality in systemic sclerosis (scleroderma). Q J Med 1992; 82:139-148.
  • 3 Nishioka K, Katayama I, Kondo H, et al. Epidemiological analysis of prognosis of 496 Japanese patients with progressive systemic sclerosis (SSc). J Dermatol 1996; 23:677-682.
  • 4 Hesselstrand R, Scheja A, Åkesson A. Mortality and causes of death in a Swedish series of systemic sclerosis patients. Ann Rheum Dis 1998; 57:682-686.
  • 5 Marie I, Hatron PY, Hachulla E, Wallaert B, Michon-Pasturel U, Devulder B. Pulmonary involvement in polymyositis and in dermatomyositis. J Rheumatol 1998; 25:1336-1343.
  • 6 Gottdiener JS, Moutsopoulos HM, Decker JL. Echocardiographic identification of cardiac abnormality in scleroderma and related disorders. Am J Med 1979; 66:391-398.
  • 7 Trell E, Lindström C. Pulmonary hypertension in systemic sclerosis. Ann Rheum Dis 1971; 30:390-400.
  • 8 Doig JC, Corris PA, Hilton CJ, Dark JH, Bexton RS. Effect of single lung transplantation on pulmonary hypertension in patients with end stage fibrosing lung disease. Br Heart J 1991; 66:431-434.
  • 9 Vigneswaran WT, McDougall JC, Olson LJ, Breen JF, McGregor CGA, Rumberger JA. Right ventricular assessment in patients presenting for lung transplantation. Transplantation 1993; 55:1051-1055.
  • 10 Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 1998; 113:576-583.
  • 11 Pattynama PMT, Willems LNA, Smit AH, Van der Wall EE, de Roos A. Early diagnosis of cor pulmonale with MR imaging of the right ventricle. Radiology 1992; 182:375-379.
  • 12 Marangoni S, Scalvini S, Schena M, Vitacca M, Quadri A, Levi G. Right ventricular diastolic function in chronic obstructive lung disease. Eur Respir J 1992; 5:438-443.
  • 13 Pattynama PMT, Lamb HJ, Van der Velde EA, Van der Wall EE, de Roos A. Left ventricular measurements by cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology 1993; 187:261-268.
  • 14 Pattynama PMT, de Roos A, Van der Wall EE, Van Voorthuisen AE. Evaluation of cardiac function with magnetic resonance imaging. Am Heart J 1994; 128:595-607.
  • 15 Pattynama PMT, Lamb HJ, Van der Velde EA, Van der Geest RJ, Van der Wall EE, de Roos A. Reproducibility of MRI-derived measurements of right ventricular volumes and myocardial mass. Magn Reson Imaging 1995; 13:53-63.
  • 16 Lamb HJ, Doornbos J, Van der Velde EA, Kruit MC, Reiber JHC, de Roos A. Echo planar MRI of the heart on a standard system: validation of measurements of left ventricular function and mass. J Comput Assist Tomogr 1996; 20:942-949.
  • 17 Mohiaddin RH, Amanuma M, Kilner PJ, Pennell DJ, Manzara C, Longmore DB. MR phase-shift velocity mapping of mitral and pulmonary venous flow. J Comput Assist Tomogr 1991; 15:237-243.
  • 18 Mostbeck GH, Hartiala JJ, Foster E, Fujita N, Dulce MC, Higgins CB. Right ventricular diastolic filling: evaluation with velocity-encoded cine MRI. J Comput Assist Tomogr 1993; 17:245-252.
  • 19 Hartiala JJ, Mostbeck GH, Foster E, et al. Velocity-encoded cine MRI in the evaluation of left ventricular diastolic function: measurement of mitral valve and pulmonary vein flow velocities and flow volume across the mitral valve. Am Heart J 1993; 125:1054-1066.
  • 20 Hartiala JJ, Foster E, Fujita N, et al. Evaluation of left atrial contribution of left ventricular filling in aortic stenosis by velocity-encoded cine MRI. Am Heart J 1994; 127:593-600.
  • 21 Heidenreich PA, Steffens J, Fujita N, et al. Evaluation of mitral stenosis with velocity-encoded cine-magnetic resonance imaging. Am J Cardiol 1995; 75:365-369.
  • 22 Rebergen SA, Helbing WA, Van der Wall EE, Maliepaard C, Chin JGJ, de Roos A. MR velocity mapping of tricuspid flow in healthy children and in patients who have undergone Mustard or Senning repair. Radiology 1995; 194:505-512.
  • 23 Helbing WA, Niezen RA, Le Cessie S, Van der Geest RJ, Ottenkamp J, de Roos A. Right ventricular diastolic function in children with pulmonary regurgitation after repair of tetralogy of Fallot: volumetric evaluation by magnetic resonance velocity mapping. J Am Coll Cardiol 1996; 28:1827-1835.
  • 24 Fraser RS, Paré JAP. Synopsis of diseases of the chest 2nd ed. Philadelphia, Pa: Saunders, 1994.
  • 25 Nishimura K, Kitaichi M, Izumi T, Nagai S, Kanaoka M, Itoh H. Usual interstitial pneumonia: histologic correlation with high-resolution CT. Radiology 1992; 182:337-342.
  • 26 Ganong WF. Energy balance, metabolism and nutrition In: Ganong WF. Review of medical physiology. Los Altos, Calif: Lange Medical, 1979; 210.
  • 27 Van der Geest RJ, Buller VGM, Jansen E, et al. Comparison between manual and semiautomated analysis of left ventricular volume parameters from short axis MR images. J Comput Assist Tomogr 1997; 21:756-765.
  • 28 Van der Geest RJ, Niezen A, Van der Wall EE, de Roos A, Reiber JHC. Automated measurement of volume flow in the ascending aorta using MR velocity maps: evaluation of inter- and intraobserver variablility in healthy volunteers. J Comput Assist Tomogr 1998; 22:904-911.
  • 29 Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta stone. J Am Coll Cardiol 1997; 30:8-18.
  • 30 Yu CM, Sanderson JE, Chan S, Yeung L, Hung YT, Woo KS. Right ventricular diastolic dysfunction in heart failure. Circulation 1996; 93:1509-1514.
  • 31 Takao M, Miyahara Y, Shinboku H, Nishiyima K, Morimitsu T, Hara K. Noninvasive assessment of right heart function by 81mKr equilibrium radionuclide ventriculography in chronic pulmonary disease. Chest 1996; 109:67-72.
  • 32 Nakamura K, Miyahara Y, Ikeda S, Naito T. Assessment of right ventricular diastolic function by pulsed Doppler echocardiography in chronic pulmonary disease and pulmonary thromboembolism. Respiration 1995; 62:237-243.
  • 33 Henein MY, Cailes J, O'Sullivan C, du Bois RM, Gibson DG. Abnormal ventricular long-axis function in systemic sclerosis. Chest 1995; 108:1533-1540.
  • 34 Miyatake K, Okamoto M, Kinoshita N, et al. Augmentation of atrial contribution to left ventricular inflow with aging as assessed by intracardiac Doppler flowmetry. Am J Cardiol 1984; 53:586-589.
  • 35 Kuo LC, Quinones MA, Rokey R, Sartory M, Abinader EG, Zhogbi WA. Quantification of atrial contribution to left ventricular filling by pulsed Doppler echocardiography and the effect of age in normal and diseased hearts. Am J Cardiol 1987; 59:1174-1178.
  • 36 Spirito P, Maron BJ. Influence of aging on Doppler echocardiographic indices of left ventricular diastolic function. Br Heart J 1988; 59:672-679.
  • 37 Zoghbi WA, Habib GB, Quinones MA. Doppler assessment of right ventricular filling in a normal population: comparison with left ventricular filling dynamics. Circulation 1990; 82:1316-1324.
  • 38 Pye MP, Pringle SD, Cobbe SM. Reference values and reproducibility of Doppler echocardiography in the assessment of the tricuspid valve and right ventricular diastolic function in normal subjects. Am J Cardiol 1991; 67:269-273.
  • 39 Benjamin EJ, Levy D, Anderson KM, et al. Determinants of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham heart study). Am J Cardiol 1992; 70:508-515.
  • 40 Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc 1994; 69:212-224.
  • 41 Yu CM, Sanderson JE. Right and left ventricular diastolic function in patients with and without heart failure: effect of age, sex, heart rate, and respiration on Doppler-derived measurements. Am Heart J 1997; 134:426-434.
  • 42 Kitzman DW, Sheikh KH, Beere PA, Philips JL, Higginbotham MB. Age-related alterations in Doppler left ventricular filling indexes in normal subjects are independent of left ventricular mass, heart rate, contractility and loading conditions. J Am Coll Cardiol 1991; 18:1243-1250.
  • 43 Schena M, Clini E, Errera D, Quadri A. Echo-Doppler evaluation of left ventricular impairment in chronic cor pulmonale. Chest 1996; 109:1446-1451.
  • 44 Sansores RH, Ramirez-Venegas A, Pérez-Padilla R, et al. Correlation between pulmonary fibrosis and the lung pressure-volume curve. Lung 1996; 174:315-323.

Article History

Published in print: Aug 2000