Right Atrial Fibrosis in Pulmonary Hypertension

  • End date
    Nov 30, 2023
  • participants needed
  • sponsor
    University of Giessen
Updated on 17 November 2021
pulmonary arterial hypertension
right heart catheterization
chronic thromboembolic pulmonary hypertension
Accepts healthy volunteers


The study aim to assess right atrial (RA) remodeling, in terms of RA fibrosis, in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension patients. This will be investigated in detail with in-depth cardiac magnet resonance imaging (CMRI). A cohort with exclusion of pulmonary hypertension which underwent CMRI due to dyspnoe of unkown reason will be the control group.


Right atrial (RA) function consists of a reservoir, conduit, and active contractile function and can serve as a tool for the evaluation of the severity of RV dysfunction and prognosis in pulmonary hypertension according to recent data. In-depth evaluation of phasic RA function was previously undertaken either by echocardiographic speckle tracking or by cardiac magnetic resonance (CMR) imaging-derived feature tracking. However, it is currently unknown if right atrial remodeling is present.

As described for left atrial fibrosis, the presence and extent of atrial fibrosis can be quantified using CMR late gadolinium enhancement. The protocol for the assessment of left atrial fibrosis will be used and adapted to the RA. Patients will undergo 3-dimensional late gadolinium enhancement CMRI along with a contrast-enhanced magnetic resonance angiography and cine imaging in order to define the anatomy of the RA and the superior and inferior vein. High-resolution late gadolinium enhancement images of the RA will be acquired 15 to 30 min after gadolinium-based contrast agents administration using a 3-dimensional inversion-recovery prepared, respiration navigated, and electrocardiogram triggered gradient-echo pulse sequence with fat saturation. Following acquisition of the scans, the endocardial borders of the RA will be defined in each slice by manual tracing. After manual adjustment of the epicardial RA surface, the quantification of fibrosis based on the relative intensity (signal intensity) of late gadolinium enhancement will be performed. Finally, a 3-dimensional model of the RA will be rendered with the maximum enhancement intensities being projected on the model surface.

Condition Primary Insulin Hypersecretion, Late Infantile Neuronal Ceroid Lipfuscinsosis, Complicated Grief, Dental Filling, Chronic Pelvic Pain, Nerve Injury, thromboembolic pulmonary hypertension, Infantile Fibrosarcoma, Pulmonary Arterial Hypertension, Pseudobulbar Affect, Memory Problems, Pelvic Adhesions, Low Testosterone, Catheter Complications, Open Heart Surgery, Functional Dyspepsia, Renal Anemia, Joint Injuries, Testotoxikose, Cancer Treatment, Myopic Macular Degeneration, Recurrent Pregnancy Loss, Surviving Abuse, Stasis Dermatitis, Serial Evaluation of Ductal Epithelium, Spine Athroplasty, Mental Disability, Severe Premenstrual Symptom, Chronic Renal Anemia, Gambling Problems, Effects of Chemotherapy, Indikation: Diabetes - Typ II, Pulmonary Hypertension, Partial Medial Meniscectomy, Abdominal Surgery, Habit Reversal, Anemic Cancer, Spinocerebellar Disorders, Chronic Thromboembolic Pulmonary Hypertension, CTEPH, Cancer Prevention
Treatment Cardiac magnetic resonance imaging
Clinical Study IdentifierNCT04663230
SponsorUniversity of Giessen
Last Modified on17 November 2021


Yes No Not Sure

Inclusion Criteria

Confirmed diagnosis of pulmonary arterial hypertension, WHO group 1 or chronic thromboembolic pulmonary hypertension, group 4
Invasive exclusion of pulmonary hypertension
Age 18 years
Signed informed consent
planned right heart catheterization based on clinical grounds

Exclusion Criteria

Other etiologic groups of pulmonary hypertension (WHO group 2, 3, 5)
Patients with congenital heart disease
Atrial septal defects
Clinical relevant left heart disease
Atrial fibrillation / Atrial flutter
Ablations of the right atrium
History of major cardiac surgery
Atrial occlude
Metallic implants
Severe renal impairment (eGFR < 30 ml/min)
Other severe disease with a life expectancy below 12 month
Any known factor or disease that might interfere with treatment compliance, study conduct, or interpretation of results
Intolerance to a contrast agent containing gadolinium
Inability to perform a cardiac magnetic resonance imaging (claustrophobia or similar)
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