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Banjade P, Subedi A, Acharya S, Itani A, Sharma M, Kassam N, Ghamande S, Surani S. The Role of Cardiac MRI in Pulmonary Hypertension- Is it Still an Underutilized Tool. Open Respir Med J 2024; 18:e18743064288565. [PMID: 39136034 PMCID: PMC11318157 DOI: 10.2174/0118743064288565240515115239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 08/15/2024] Open
Abstract
Pulmonary hypertension (PH) is an intricate medical issue resulting from increased pressure in the pulmonary artery (PA). The current gold standard for diagnosis involves an invasive procedure known as right heart catheterization. Nevertheless, cardiac magnetic resonance imaging (cMRI) offers a non-invasive and valuable alternative for evaluating the function, structure, and blood flow through the pulmonary artery (PA) in both the left ventricle (LV) and right ventricle (RV). Additionally, cMRI can be a good tool for predicting mortality by assessing various hemodynamic parameters. We perceive that cMRI may be an underutilized tool in the evaluation of PH. More discussions might be needed to highlight its utility in patients with PH. This article aims to discuss the potential role of cMRI in evaluating PH based on the review of recent literature.
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Affiliation(s)
- Prakash Banjade
- Department of Medicine, Manipal College of Medical Sciences, Pokhara, 33700, Nepal
| | - Ashish Subedi
- Department of Medicine, Gandaki Medical College, Pokhara, 33700, Nepal
| | - Sampada Acharya
- Department of Medicine, Chitwan Medical College, Bharatpur, 44200, Nepal
| | - Asmita Itani
- Department of Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, 44600, Nepal
| | - Munish Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White, Texas, USA
| | - Nadeem Kassam
- Department of Medicine, Aga Khan University, Nairobi, 30270, Kenya
| | - Shekhar Ghamande
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White, Texas, USA
| | - Salim Surani
- Division of Pulmonary, Critical Care and Sleep Medicine, Adjunct Clinical Professor, Texas A & M University, Texas, USA
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Xu W, Deng M, Zhang L, Zhang P, Gao Q, Tao X, Zhen Y, Liu X, Jin N, Chen W, Xie W, Liu M. Qualification of Ventricular Flow in Patients With Precapillary Pulmonary Hypertension With 4-dimensional Flow Magnetic Resonance Imaging. J Thorac Imaging 2023; 38:00005382-990000000-00068. [PMID: 37199439 PMCID: PMC10597405 DOI: 10.1097/rti.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE Our goal was to study both right and left ventricular blood flow in patients with precapillary pulmonary hypertension (pre-PH) with 4-dimensional (4D) flow magnetic resonance imaging (MRI) and to analyze their correlation with cardiac functional metrics on cardiovascular magnetic resonance (CMR) and hemodynamics from right heart catheterization (RHC). MATERIALS AND METHODS 129 patients (64 females, mean age 47 ± 13 y) including 105 patients with pre-PH (54 females, mean age 49 ± 13 y) and 24 patients without PH (10 females, mean age 40 ± 12 y) were retrospectively included. All patients underwent CMR and RHC within 48 hours. 4D flow MRI was acquired using a 3-dimensional retrospectively electrocardiograph-triggered, navigator-gated phase contrast sequence. Right and left ventricular flow components including the percentages of direct flow (PDF), retained inflow (PRI), delayed ejection flow (PDE), and residual volume (PRVo) were respectively quantified. The ventricular flow components between patients with pre-PH and non-PH were compared and correlations of flow components with CMR functional metrics and hemodynamics measured with RHC were analyzed. Biventricular flow components were compared between survivors and deceased patients during the perioperative period. RESULTS Right ventricular (RV) PDF and PDE significantly correlated with RVEDV and RV ejection fraction. RV PDF negatively correlated with pulmonary arterial pressure (PAP) and pulmonary vascular resistance. When the RV PDF was <11%, the sensitivity and specificity of RV PDF for predicting mean PAP ≥25 mm Hg were 88.6% and 98.7%, respectively, with an area under the curve value of 0.95 ± 0.02. When RV PRVo was more than 42%, the sensitivity and specificity of RV PRVo for predicting mean PAP ≥25 mm Hg were 85.7% and 98.5%, respectively, with an area under the curve value of 0.95 ± 0.01. Nine patients died during the perioperative period. Biventricular PDF, RV PDE, and PRI of survivors were higher than nonsurvivors whereas RV PRVo increased in deceased patients. CONCLUSIONS Biventricular flow analysis with 4D flow MRI provides comprehensive information about the severity and cardiac remodeling of PH and may be a predictor of perioperative death of patients with pre-PH.
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Affiliation(s)
- Wenqing Xu
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Mei Deng
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | | | - Qian Gao
- Department of Pulmonary and Critical Care Medicine
| | - Xincao Tao
- Department of Pulmonary and Critical Care Medicine
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Ning Jin
- Siemens Medical Solution, Chicago, IL, USA
| | - Wenhui Chen
- Department of Pulmonary and Critical Care Medicine
| | - Wanmu Xie
- Department of Pulmonary and Critical Care Medicine
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Xu W, Sun X, Tao X, Wang D, Zhen Y, Liu X, An J, Xie W, Liu M. Characteristics of Right Ventricular Blood Flow in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Analysis With 4-Dimensional Flow Cardiovascular Magnetic Resonance Imaging. Front Cardiovasc Med 2022; 9:900301. [PMID: 35783864 PMCID: PMC9240307 DOI: 10.3389/fcvm.2022.900301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBlood flow is closely related to function, but currently, the relationship of right ventricular (RV) blood flow components with RV function and hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. Our objective is to qualify RV function with 4-dimensional flow cardiovascular magnetic resonance (4D-Flow CMR) imaging and to investigate the correlation between RV flow and hemodynamics in patients with CTEPH.MethodsRetrospective enrollment included 67 patients with CTEPH (mean age 47.8±14.2 years, 47 men) who underwent CMR and right heart catheterization (RHC) within 2 days. RHC was used to evaluate hemodynamics. RV flow components including the percentages of direct flow (PDF), retained inflow (PRI), delayed ejection flow (PDEF), and residual volume (PRVo) were quantified on 4D-Flow sequence. RV functional metrics were determined with the CINE balanced steady-state free precession sequence. The sum of PDF and PDEF was compared with RV eject fraction (RVEF). The correlation among RV flow components, RV functional metrics and hemodynamics was analyzed with spearman correlation analysis.ResultsThe median (interquartile range) of RVEF, PDF, PDEF, PRI, and PRVo, respectively was 35.5% (18.2, 45.6%), 18% (8.4, 21.4%), 15.1% (13.5, 19.0%), 15.9% (13.8, 20.8%), and 50.6% (35.6, 60.4%). The sum of PDF and PDEF is 35.1% (24.8, 46.6%), which was similar to RVEF (z = 0.58, p = 0.561). PDF negatively correlated with right ventricular end-systolic volume index (RVESVI), right ventricular myocardial mass index (RVMI) and right ventricular global longitudinal strain (r = −0.61, −0.65, −0.64, p < 0.001). PRVo positively correlated with RVESVI and RVMI (r = 0.50, 0.58, p < 0.001). PDF negatively correlated with pulmonary vascular resistance (PVR) (r = −0.72, p < 0.001) while it positively correlated with cardiac output (CO) and cardiac index (CI) (r = 0.64 & 0.52, p < 0.001). PRVo positively correlated with mean pulmonary pressure and PVR (r = 0.57&0.54, p < 0.001). Total five patients died in the perioperative period. RVEF in the deceased patients was similar to survivors (z = −1.163, p = 0.092). In comparison with the survivors, RVPDF in the deceased patients significantly reduced (z = −2.158, p = 0.029) while RVPDEF, RVPRI, and RVPRVo in deceased patients were similar to survivors.Conclusion4D-Flow CMR can provide simultaneous quantification of RV function and hemodynamics in the assessment of CTEPH without breath-holding. The reduced PDF and increased PRVo were the main characteristics of RV flow in CTEPH.
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Affiliation(s)
- Wenqing Xu
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xuebiao Sun
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xincao Tao
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Dingyi Wang
- China-Japan Friendship Hospital, Institute of Clinical Medical Sciences, Beijing, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shanghai, China
| | - Wanmu Xie
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Min Liu
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