Magnetic Resonance Imaging in the Prognostic Evaluation of Patients with Pulmonary Arterial Hypertension

Abstract

MRI measurements reflecting right ventricular structure and stiffness of the proximal pulmonary vasculature are independent predictors of outcome in PAH. In combination with clinical data MRI has moderate prognostic accuracy in the evaluation of patients with PAH.

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

“…Table E1 in the online supplement provides an overview of the prognostic capabilities of RHC-, echocardiography-, and CMR-derived variables in various types of severe PH. Various combinations of these parameters have been used in prediction models (129,130). RHC-derived predictors of outcomes include CO (measured or calculated from mixed venous blood oxygenation) (131)(132)(133)(134)(135), right atrial pressure (132)(133)(134)136), PVR (135)(136)(137), and PAP (133).…”

“…These data suggest that echocardiography offers prognostication via measurements of RV systolic function (TAPSE, velocity of isovolumic contraction, dP/dt, strain, myocardial performance index, contractile reserve), dimensions, and estimates of filling pressures. CMR-derived predictors include SV (21,154), end-diastolic volume (21,155), RVEF (3,154,156), end-systolic volume (ESV) (129,157), SV/ESV (3), and late gadolinium enhancement (158). The latter, however, is not uniformly confirmed (159).…”

Children with kawasaki disease present elevated stiffness of great arteries: Phase‐contrast MRI study

“…PC‐MRI computed PWV allows for segment‐specific analysis of vascular stiffness, and considers the heterogeneity in vessel wall composition, vessel branching, and backward wave reflections, all typically unevaluated in tonometry‐based studies . Importantly, central aortic and MPA stiffness assessed by PWV have been shown to be prognostic of cardiovascular events with respect to both systemic and pulmonary vasculatures, including hypertension, atherosclerosis, and aneurysmal processes . Consequently, PC‐MRI derived PWV in patients with a history of KD may provide more specific information on arterial health status and improve the prognostic ability of vascular stiffness in this patient population.…”

“…12,[14][15][16] Importantly, central aortic and MPA stiffness assessed by PWV have been shown to be prognostic of cardiovascular events with respect to both systemic and pulmonary vasculatures, including hypertension, atherosclerosis, and aneurysmal processes. 17,18 Consequently, PC-MRI derived PWV in patients with a history of KD may provide more specific information on arterial health status and improve the prognostic ability of vascular stiffness in this patient population.…”

Broader implications for the widened pulmonary artery?

“…Reduction in relative area change (i.e. ‘stiffness’) of the main PA is an independent predictor of survival in PAH …”