Multiparametric Cardio-hepatic MRI in Patients With Noncirrhotic Portal Hypertension

Study Overview
=================
Brief Summary
-----------------
The aim of this study is to use multiparametric MRI to investigate any differences in myocardial structure and function in patients with noncirrhotic portal hypertension compared with a control group with liver cirrhosis.

Detailed Description
-----------------
The term cirrhotic cardiomyopathy (CCM) was defined in 2005 according to expert consensus at the World Congress of Gastroenterology in Montreal as a clinical phenotype in patients with liver cirrhosis consisting of systolic and diastolic dysfunction and a complementary criterion, such as electrophysiological changes, without the presence of a known underlying cardiac disease. For a long time, CCM was considered to result from toxic effects of alcohol consumption. The current view is that CCM is a separate entity independent of the various etiologies of liver cirrhosis. Thus, generally impaired liver function and portal hypertension with splanchnic vasodilation leads to altered hemodynamic conditions with central hypovolemia, increased activation of volume and baroreceptors, especially of the sympathetic nervous system, resulting in a hyperdynamic syndrome with increased cardiac stress. However, the contribution of portal hypertension to CCM is unclear. With new MRI techniques such as cardiac T1 and T2 mapping and extracellular volume fraction (ECV), quantitative parameters are available to detect pathologies of the myocardium before they become detectable with conventional techniques in cardiac MRI or echocardiography. The aim of this study is to use multiparametric MRI to investigate any differences in myocardial structure and function in patients with noncirrhotic portal hypertension compared with a control group with liver cirrhosis and to investigate a quantifiable correlation between cardiac, hepatic, and splenic parameters.

Official Title
-----------------
Multiparametric Cardio-hepatic MRI in Patients With Noncirrhotic Portal Hypertension

Conditions
-----------------
Hypertension, Portal, Cardiomyopathies

Intervention / Treatment
-----------------
* Diagnostic Test: Cardiac magnetic resonance scan


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion criteria: noncirrhotic portal hypertension age at least 18 years Exclusion criteria: underlying cardiac disease, e.g., coronary heart disease/myocardial infarction, myocarditis, cardiomyopathies of other causes, congenital heart disease patients who are using a intrauterinpessare for contraception pregnant and breastfeeding women patients with contraindications for MRI (not suitebale metallic implants) patients with contraindications for MRI contrast agents (renal insufficiency, allergy)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Noncirrhotic portal hypertension (NCPH)<br>Patients with non-cirrhotic portal hypertension (NCPH) with pre-sinusoidal (e.g., porto-sinusoidal vascular disease, portal vein obstruction, congenital hepatic fibrosis, biliary diseases,), sinusoidal (e.g., sinusoidal destruction in the setting of acute hepatic injury, inflammatory or toxic fibrosis, non-alcoholic steatohepatitis), or post-sinusoidal causes (Budd-Chiari syndrome, sinusoidal obstruction syndrome). | Diagnostic Test: Cardiac magnetic resonance scan<br>* Multiparametric cardiac magnetic resonance, including functional and structural parameters<br>|
| Cirrhotic portal hypertension<br>Patients with cirrhosis and portal hypertension. | Diagnostic Test: Cardiac magnetic resonance scan<br>* Multiparametric cardiac magnetic resonance, including functional and structural parameters<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Myocardial T1 relaxation time | T1 relaxation times will be obtained to asses acute myocardial injury and fibrosis. T1 maps will be analyzed using a segmental approach by region of interest analysis. T1 relaxation times are given in [ms]. | Measurement will be performed within 2 weeks after MRI scan. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Myocardial T2 relaxation time | T2 relaxation times will be obtained to asses myocardial edema. T2 maps will be analyzed using a segmental approach by region of interest analysis. T2 relaxation times are given in [ms]. | Measurement will be performed within 2 weeks after MRI scan. | 
| Myocardial ECV | Myocardial extracellular volume will be obtained to asses extracellular space/myocardial fibrosis. ECV values will be calculated using a segmental approach by region of interest analysis of native and contrast-enhanced T1 relaxation maps. ECV values are given in [%]. | Measurement will be performed within 2 weeks after MRI scan. | 
| Myocardial strain | Cardiac magnetic resonance feature-tracking will be used to asses left ventricular longitudinal, circumferential and radial strain. | Measurement will be performed within 2 weeks after MRI scan. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Cardiac MRI, Hepatic MRI