Ursula Reiter1, Gabor Kovacs2,3, Clemens Reiter4, Corina Kräuter4,5, Volha Nizhnikava4, Michael Fuchsjäger4, Horst Olschewski2,3, Gert Reiter4,6. 1. Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria. ursula.reiter@medunigraz.at. 2. Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 3. Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria. 4. Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria. 5. Institute of Medical Engineering, Graz University of Technology, Graz, Austria. 6. Research & Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria.
Abstract
OBJECTIVES: Longitudinal hemodynamic follow-up is important in the management of pulmonary hypertension (PH). This study aimed to evaluate the potential of MR 4-dimensional (4D) flow imaging to predict changes in the mean pulmonary arterial pressure (mPAP) during serial investigations. METHODS: Forty-four adult patients with PH or at risk of developing PH repeatedly underwent routine right heart catheterization (RHC) and near-term MR 4D flow imaging of the main pulmonary artery. The duration of vortical blood flow along the main pulmonary artery was evaluated from MR 4D velocity fields using prototype software and converted to an MR 4D flow imaging-based mPAP estimate (mPAPMR) by a previously established model. The relationship of differences between RHC-derived baseline and follow-up mPAP values (ΔmPAP) to corresponding differences in mPAPMR (ΔmPAPMR) was analyzed by means of regression and Bland-Altman analysis; the diagnostic performance of ΔmPAPMR in predicting mPAP increases or decreases was investigated by ROC analysis. RESULTS: Areas under the curve for the prediction of mPAP increases and decreases were 0.92 and 0.93, respectively. With the natural cutoff ΔmPAPMR = 0 mmHg, mPAP increases (decreases) were predicted with an accuracy, sensitivity, and specificity of 91% (91%), 85% (89%), and 94% (92%), respectively. For patients in whom 4D flow allowed a point estimate of mPAP (mPAP > 16 mmHg), ΔmPAPMR correlated strongly with ΔmPAP (r = 0.91) and estimated ΔmPAP bias-free with a standard deviation of 5.1 mmHg. CONCLUSIONS: MR 4D flow imaging allows accurate non-invasive prediction and quantification of mPAP changes in adult patients with PH or at risk of developing PH. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00575692 and NCT01725763 KEY POINTS: • MR 4D flow imaging allows accurate non-invasive prediction of mean pulmonary arterial pressure increases and decreases in adult patients with or at risk of developing pulmonary hypertension. • In adult patients with mean pulmonary arterial pressure > 16 mmHg, MR 4D flow imaging allows estimation of longitudinal mean pulmonary arterial pressure changes without bias with a standard deviation of 5.1 mmHg.
OBJECTIVES: Longitudinal hemodynamic follow-up is important in the management of pulmonary hypertension (PH). This study aimed to evaluate the potential of MR 4-dimensional (4D) flow imaging to predict changes in the mean pulmonary arterial pressure (mPAP) during serial investigations. METHODS: Forty-four adult patients with PH or at risk of developing PH repeatedly underwent routine right heart catheterization (RHC) and near-term MR 4D flow imaging of the main pulmonary artery. The duration of vortical blood flow along the main pulmonary artery was evaluated from MR 4D velocity fields using prototype software and converted to an MR 4D flow imaging-based mPAP estimate (mPAPMR) by a previously established model. The relationship of differences between RHC-derived baseline and follow-up mPAP values (ΔmPAP) to corresponding differences in mPAPMR (ΔmPAPMR) was analyzed by means of regression and Bland-Altman analysis; the diagnostic performance of ΔmPAPMR in predicting mPAP increases or decreases was investigated by ROC analysis. RESULTS: Areas under the curve for the prediction of mPAP increases and decreases were 0.92 and 0.93, respectively. With the natural cutoff ΔmPAPMR = 0 mmHg, mPAP increases (decreases) were predicted with an accuracy, sensitivity, and specificity of 91% (91%), 85% (89%), and 94% (92%), respectively. For patients in whom 4D flow allowed a point estimate of mPAP (mPAP > 16 mmHg), ΔmPAPMR correlated strongly with ΔmPAP (r = 0.91) and estimated ΔmPAP bias-free with a standard deviation of 5.1 mmHg. CONCLUSIONS: MR 4D flow imaging allows accurate non-invasive prediction and quantification of mPAP changes in adult patients with PH or at risk of developing PH. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00575692 and NCT01725763 KEY POINTS: • MR 4D flow imaging allows accurate non-invasive prediction of mean pulmonary arterial pressure increases and decreases in adult patients with or at risk of developing pulmonary hypertension. • In adult patients with mean pulmonary arterial pressure > 16 mmHg, MR 4D flow imaging allows estimation of longitudinal mean pulmonary arterial pressure changes without bias with a standard deviation of 5.1 mmHg.
Entities:
Keywords:
Follow-up studies; Hemodynamics; Magnetic resonance imaging; Pulmonary hypertension
Authors: Vallerie V McLaughlin; Sean Patrick Gaine; Luke S Howard; Hanno H Leuchte; Michael A Mathier; Sanjay Mehta; Massimillano Palazzini; Myung H Park; Victor F Tapson; Olivier Sitbon Journal: J Am Coll Cardiol Date: 2013-12-24 Impact factor: 24.094
Authors: F C Roller; S Kriechbaum; A Breithecker; C Liebetrau; M Haas; C Schneider; A Rolf; S Guth; E Mayer; C Hamm; G A Krombach; C B Wiedenroth Journal: Eur Radiol Date: 2018-08-29 Impact factor: 5.315
Authors: Nazzareno Galiè; Marc Humbert; Jean-Luc Vachiery; Simon Gibbs; Irene Lang; Adam Torbicki; Gérald Simonneau; Andrew Peacock; Anton Vonk Noordegraaf; Maurice Beghetti; Ardeschir Ghofrani; Miguel Angel Gomez Sanchez; Georg Hansmann; Walter Klepetko; Patrizio Lancellotti; Marco Matucci; Theresa McDonagh; Luc A Pierard; Pedro T Trindade; Maurizio Zompatori; Marius Hoeper Journal: Eur Heart J Date: 2015-08-29 Impact factor: 29.983
Authors: Andrew J Swift; Smitha Rajaram; Robin Condliffe; Dave Capener; Judith Hurdman; Charlie A Elliot; Jim M Wild; David G Kiely Journal: J Cardiovasc Magn Reson Date: 2012-06-21 Impact factor: 5.364
Authors: C S Johns; S Rajaram; D A Capener; C Oram; C Elliot; R Condliffe; D G Kiely; J M Wild; A J Swift Journal: Eur Radiol Date: 2017-11-16 Impact factor: 5.315
Authors: Gérald Simonneau; David Montani; David S Celermajer; Christopher P Denton; Michael A Gatzoulis; Michael Krowka; Paul G Williams; Rogerio Souza Journal: Eur Respir J Date: 2019-01-24 Impact factor: 16.671
Authors: Andrew J Swift; Jim M Wild; Scott K Nagle; Alejandro Roldán-Alzate; Christopher J François; Sean Fain; Kevin Johnson; Dave Capener; Edwin J R van Beek; David G Kiely; Kang Wang; Mark L Schiebler Journal: J Thorac Imaging Date: 2014-03 Impact factor: 3.000
Authors: Andrew J Swift; Smitha Rajaram; Judith Hurdman; Catherine Hill; Christine Davies; Tom W Sproson; Allison C Morton; Dave Capener; Charlie Elliot; Robin Condliffe; Jim M Wild; David G Kiely Journal: JACC Cardiovasc Imaging Date: 2013-06-13
Authors: Gert Reiter; Gabor Kovacs; Clemens Reiter; Albrecht Schmidt; Michael Fuchsjäger; Horst Olschewski; Ursula Reiter Journal: Front Cardiovasc Med Date: 2022-08-03
Authors: Jean-François Deux; Lindsey A Crowe; Léon Genecand; Anne-Lise Hachulla; Carl G Glessgen; Stéphane Noble; Maurice Beghetti; Jin Ning; Daniel Giese; Frédéric Lador; Jean-Paul Vallée Journal: J Clin Med Date: 2022-09-05 Impact factor: 4.964