Diagnosis of Pulmonary Hypertension with Cardiac MRI: Derivation and Validation of Regression Models

Johns, Chris; Kiely, David G.; Rajaram, Smitha; Hill, Catherine; Thomas, Steven; Karunasaagarar, Kavitasagary; Garg, Pankaj; Hamilton, Neil; Solanki, Roshni; Capener, David; Elliot, Charles; Sabroe, Ian; Charalamopopoulos, Athanasios; Condliffe, Robin; Wild, Jim M.; Swift, Andrew J.

doi:10.1148/radiol.2018180603

Cited by 50 publications

(49 citation statements)

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“…Cardiac MRI has been used to estimate mPAP to provide diagnosis through non-invasive means. A recent study developed regression models to predict mPAP based on cardiac MRI [15]. A cohort of 600 patients who had both CMR and RHC was retrospectively included.…”

Section: Diagnosismentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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Purpose of Review This article reviews advances over the past 3 years in cardiac magnetic resonance (CMR) imaging in pulmonary hypertension (PH). We aim to bring the reader up-to-date with CMR applications in diagnosis, prognosis, 4D flow, strain analysis, T1 mapping, machine learning and ongoing research. Recent Findings CMR volumetric and functional metrics are now established as valuable prognostic markers in PH. This imaging modality is increasingly used to assess treatment response and improves risk stratification when incorporated into PH risk scores. Emerging techniques such as myocardial T1 mapping may play a role in the follow-up of selected patients. Myocardial strain may be used as an early marker for right and left ventricular dysfunction and a predictor for mortality. Machine learning has offered a glimpse into future possibilities. Ongoing research of new PH therapies is increasingly using CMR as a clinical endpoint. Summary The last 3 years have seen several large studies establishing CMR as a valuable diagnostic and prognostic tool in patients with PH, with CMR increasingly considered as an endpoint in clinical trials of PH therapies. Machine learning approaches to improve automation and accuracy of CMR metrics and identify imaging features of PH is an area of active research interest with promising clinical utility.

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Section: Diagnosismentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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“…Even though the role of cardiac MRI in the clinical management of PH is not yet established, the method offers various tools particularly suitable for PH treatment monitoring and patient follow-up. Allowing for an accurate evaluation of cardiac function and morphology, various quantitative MRI parameters have been reported to be significantly altered in PH [7][8][9][10][11][12][13][14][15][16][17][18][19][20] including, among others, the appearance of vortical blood flow along the main pulmonary artery as assessed by time-resolved, three-directional MR phase contrast (4D flow) imaging [19,[21][22][23][24][25][26][27][28]. Moreover, the duration of vortical blood flow was introduced as a potential 4D flow metric for accurate non-invasive estimation of elevated mPAP [26,27], making MR 4D flow imaging particularly interesting for noninvasive mPAP tracking.…”

Section: Introductionmentioning

confidence: 99%

MR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension

et al. 2020

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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.

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“…he Sixth World Symposium on Pulmonary Hypertension recommends that precapillary pulmonary hypertension (PH) be deined by a mean pulmonary artery pressure (mPAP) of greater than 20 mm Hg as well as a pulmonary vascular resistance (PVR) of at least 3 Woods units (WU) (1). Herein, we update the results from our article published in the January 2019 issue of Radiology (2) to relect this new threshold. In our study, we derived two regression models based on cardiopulmonary vascular MRI measurements to predict mPAP in a population of patients with suspected PH from the ASPIRE registry (Assessing the Spectrum of Pulmonary Hypertension Identiied at a Referral Center).…”

Section: Editormentioning

confidence: 92%