Cardiac magnetic resonance imaging in pulmonary arterial hypertension

Peacock, Andrew J.; Noordegraaf, Anton Vonk

doi:10.1183/09059180.00006313

Cited by 74 publications

(56 citation statements)

References 54 publications

(68 reference statements)

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“…In patients with suspected PH, the presence of late gadolinium enhancement, reduced pulmonary arterial distensibility and retrograde flow have high predictive value for the identification of PH; however, no single CMR measurement can exclude PH [60][61][62]. In patients with PH, CMR may also be useful in cases of suspected CHD if echocardiography is not conclusive.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

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Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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“…69 A subsequent further increase in RV volumes and a decrease in stroke volume during treatment are clear signs of progressive RV failure and can be observed before failure becomes clinically manifest. 7,12 This is illustrated in Figure 4, which shows a patient with progressive RV dilatation over the years together with a decrease in stroke volume, preceding clinical failure. Close monitoring of RV volumes and function offers the possibility for early therapeutic interventions, but the impact of such a strategy on patient outcomes has yet to be studied.…”

Section: Cardiac Mri Volumetric Measurementsmentioning

confidence: 99%

“…Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart. [2][3][4][5][6][7] PET is also offering novel insights into perfusion and blood flow, metabolism, neurohormonal activation, and other molecular processes in the right side of the heart but is used mainly for research at this time. Catheterization of the right side of the heart remains the gold standard for defining PH and assessing hemodynamics both at rest and with exercise.…”

mentioning

confidence: 99%

“…1,2 The second was the emergence of multimodality imaging with a complementary role for echocardiography, magnetic resonance (MRI), computed tomography, and positron emission tomography (PET). [2][3][4][5][6][7] These techniques not only help in the diagnosis of PH but also help identify factors that determine risk and prognosis and gauge therapeutic effects on right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart.…”

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confidence: 99%

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Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

et al. 2015

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899N oninvasive imaging plays a key role in both the diagnosis and management of patients with pulmonary hypertension (PH). In recent years, there have been 2 major changes in perspective of imaging in PH. The first was the realization that imaging should focus on the evaluation of not only the pulmonary pressures but also the cardiopulmonary unit ( Figure 1). 1,2The second was the emergence of multimodality imaging with a complementary role for echocardiography, magnetic resonance (MRI), computed tomography, and positron emission tomography (PET).2-7 These techniques not only help in the diagnosis of PH but also help identify factors that determine risk and prognosis and gauge therapeutic effects on right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart. 2-7 PET is also offering novel insights into perfusion and blood flow, metabolism, neurohormonal activation, and other molecular processes in the right side of the heart but is used mainly for research at this time. Catheterization of the right side of the heart remains the gold standard for defining PH and assessing hemodynamics both at rest and with exercise. Invasive assessment of cardiac output (CO) may, however, have limited accuracy when assumed instead of measured oxygen consumption is used to derive CO (eg, using the Fick method) or when thermodilution is used in the setting of a low-CO state. [8][9][10] This review covers RV imaging studies performed in the field of PH and discusses recent advances in echocardiography and cardiac MRI and PET imaging for detailed assessment of RV function. The review starts with a discussion of important physiological considerations and unmet needs in imaging research of the right side of the heart in PH. Computed tomography angiography, which plays an important role in evaluating chronic thromboembolic PH, is not discussed extensively in this review. Physiological ConsiderationsAlthough PH is a syndrome affecting the pulmonary vasculature, survival of patients with PH is closely related to RV function. 1,[11][12][13][14] The RV initially adapts to the increased afterload by increasing its wall thickness and contractility. These mechanisms are, however, often insufficient, and RV dysfunction eventually occurs. After the recent Fifth World Symposium on Pulmonary Hypertension, a definition of failure of the right side of the heart secondary to PH was adopted: "Right heart failure in the setting of PH can be defined as a complex clinical syndrome due to a suboptimal delivery of blood or elevated systemic venous pressure at rest or exercise as a consequence of elevated RV afterload."2 The proposed definition takes into account both the systolic and diastolic characteristics of function of the right side of the heart, as well as physiological demands such as exercise.In underst...

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“…35 In addition, CMR offers the possibility to quantify regurgitant volumes, use delayed gadolinium enhancement as a marker for focal scar burden, and to assess myocardial strain, coronary perfusion, and pulmonary pulsatility. 36 One recent study was able to predict survival in patients with PAH based on the RV ejection fraction computed from CMR. 37 A more recent multicenter study demonstrated the feasibility of using CMR to track changes in RV size and function in response to 12 months of PAH-specific therapy.…”

Section: Cardiac Mrimentioning

confidence: 99%

Clinical Diagnosis of Pulmonary Hypertension

Rich

2014

Circulation

102

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1820T here has been an increased recognition of pulmonary hypertension (PH) in clinical practice over the past 30 years. It is likely that this rise in PH diagnoses is attributable to multiple factors, including increased awareness by clinicians, the routine use of diagnostic tools such as Doppler echocardiography, and the availability and marketing of the many PH-specific drugs.1 Although the increased awareness of the disease should be viewed as a favorable development, the unintended consequences include overdiagnosis, misclassification, and at times indiscriminate use of expensive, PH-specific drugs. In this review, we address the epidemiology, prognosis, and updated clinical classification of PH. We then focus on the diagnostic approach to the patient with suspected PH with an emphasis placed on highlighting key pearls for the clinician to consider. Finally, we review an evolving conceptual framework of viewing the pulmonary vasculature and the right ventricle as a single, coupled cardiopulmonary unit.

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Cardiac magnetic resonance imaging in pulmonary arterial hypertension

Cited by 74 publications

References 54 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Clinical Diagnosis of Pulmonary Hypertension

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