PurposeTo derive and test multiparametric cardiac MRI models for the diagnosis
of pulmonary hypertension (PH).Materials and MethodsImages and patient data from consecutive patients suspected of having PH
who underwent cardiac MRI and right-sided heart catheterization (RHC)
between 2012 and 2016 were retrospectively reviewed. Of 2437 MR images
identified, 603 fit the inclusion criteria. The mean patient age was 61
years (range, 18–88 years; mean age of women, 60 years [range,
18–84 years]; mean age of men, 62 years [range, 22–88
years]). In the first 300 patients (derivation cohort), cardiac MRI
metrics that showed correlation with mean pulmonary arterial pressure
(mPAP) were used to create a regression algorithm. The performance of
the model was assessed in the 303-patient validation cohort by using
receiver operating characteristic (ROC) and χ2
analysis.ResultsIn the derivation cohort, cardiac MRI mPAP model 1 (right ventricle and
black blood) was defined as follows: −179 + loge
interventricular septal angle × 42.7 + log10
ventricular mass index (right ventricular mass/left ventricular mass)
× 7.57 + black blood slow flow score × 3.39. In the
validation cohort, cardiac MRI mPAP model 1 had strong agreement with
RHC-measured mPAP, an intraclass coefficient of 0.78, and high
diagnostic accuracy (area under the ROC curve = 0.95; 95%
confidence interval [CI]: 0.93, 0.98). The threshold of at least 25 mm
Hg had a sensitivity of 93% (95% CI: 89%, 96%), specificity of 79% (95%
CI: 65%, 89%), positive predictive value of 96% (95% CI: 93%, 98%), and
negative predictive value of 67% (95% CI: 53%, 78%) in the validation
cohort. A second model, cardiac MRI mPAP model 2 (right ventricle
pulmonary artery), which excludes the black blood flow score, had
equivalent diagnostic accuracy (ROC difference: P
= .24).ConclusionMultiparametric cardiac MRI models have high diagnostic accuracy in
patients suspected of having pulmonary hypertension.Published under a CC BY 4.0 license.Online
supplemental material is available for this
article.See also the editorial by Colletti in this issue.