Pulmonary hypertension: pulmonary flow quantification and flow profile analysis with velocity-encoded cine MR imaging.

Kondo, Chisato; Caputo, Gary R.; Masui, Takayuki; Foster, Elyse; O’Sullivan, Margaret; Stulbarg, Michael S.; Golden, Jeff; Catterjee, Kanu; Higgins, Charles B.

doi:10.1148/radiology.183.3.1584932

Cited by 153 publications

(72 citation statements)

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“…Early studies using the phase-contrast technique and velocityencoded MRI showed the feasibility of estimating right-side hemodynamics, 100,101 but the ease of Doppler echocardiography has limited the enthusiasm of proceeding with large-scale validation studies. Furthermore, these parameters are dependent on many factors beyond the pulmonary microcirculation; eg, pulmonary flow increases in anemia or in liver failure, resulting in increased systolic PAPs without a true increase in PVR.…”

Section: Pulmonary Vascular Perfusionmentioning

confidence: 99%

Comprehensive Invasive and Noninvasive Approach to the Right Ventricle–Pulmonary Circulation Unit

2009

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T here is still no answer to William Harvey's rhetorical question. He included the right ventricle (RV), its "pulse," the large pulmonary arteries (PAs), and the lungs in the same sentence, emphasizing the concept of a "unit." Although Harvey realized the importance of the RV and its interactions with the pulmonary circulation, 4 centuries later, the RV is largely understudied. At the same time, there has been significant progress in our understanding of the pathology of pulmonary vascular disease and, over the past few years, an explosion of clinical therapeutic trials for PA hypertension (PAH). 1 This unbalanced approach has generated a number of problems and controversies. For example, it is now becoming apparent that even if experimental therapies improve or reverse PAH pathology, this does not necessarily lead to clinical improvement and prolonged survival unless accompanied by a parallel improvement in RV function. The degree of pulmonary hypertension (ie, PA pressure [PAP]) does not strongly correlate with symptoms or survival, whereas RV mass and size and right atrial pressure reflect functional status and are strong predictors of survival. 2 The 6-minute walk test, used as the primary end point in most PAH clinical trials, correlates better with RV function (ie, cardiac output) than with the degree of pulmonary pressure elevation. However, this test is being heavily criticized because of multiple inherent problems and the fact that it does not provide information on specific components of RV-pulmonary vascular function. 3 Although therapies aiming at reversing pulmonary vascular remodeling might also have a positive effect on the RV (eg, sildenafil, which has been shown to increase RV inotropy 4 and decrease RV hypertrophy, 5 in addition to its effects on the pulmonary circulation), others might have untoward effects on the RV. For example, imatinib, an antiproliferative/proapoptotic agent that shows preliminary promise in reversing pulmonary vascular remodeling, 6 is potentially associated with primary negative (ie, proapoptotic) effects on the myocardium. 7 As our knowledge of RV physiology and biology increases, it is becoming apparent that a comprehensive approach to the RV, the pulmonary circulation, and their interactions will be beneficial in both clinical management of PAH patients and clinical research. The evolution of RV pathology from the normal to a compensated (hypertrophied) and then decompensated state parallels the evolution of pulmonary vascular pathology from a vasodilated highcapacitance state to vasoconstricted arteries and early loss of endothelial cells/capillaries to an end-stage proliferative and obliterative vascular remodeling (Figure 1). Therefore, it is important to study the RV and the PAs comprehensively and simultaneously as a unit. Here, we discuss standard clinical tests (eg, right heart catheterization and echocardiography) and evolving technologies (eg, magnetic resonance [MR] imaging [MRI] and positron emission tomography [PET]) that have the ability to study the ...

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Section: Pulmonary Vascular Perfusionmentioning

confidence: 99%

Comprehensive Invasive and Noninvasive Approach to the Right Ventricle–Pulmonary Circulation Unit

2009

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“…Parameters that directly correlate with mPAP or pulmonary vascular resistance have been related to the shortened acceleration times of blood flow in the right ventricular outflow tract. 2,3,[7][8][9][10][11] However, the overall applicability and accuracy of the above-described methods are controversial. [12][13][14][15][16] Additionally, various authors 10,11,17,18 have observed spatially highly inhomogeneous cross-sectional flow profiles and fractions of retrograde flow during systole and diastole in the main pulmonary artery in patients with PH.…”

Section: Clinical Perspective See P 30mentioning

confidence: 99%

Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure

Reiter

Kovàcs

et al. 2008

Circ: Cardiovascular Imaging

214

194

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Background-Pulmonary hypertension is a disease characterized by an elevation in pulmonary arterial pressure that is diagnosed invasively via right heart catheterization. Such pathological altered pressures in the pulmonary vascular system should lead to changes in blood flow patterns in the main pulmonary artery. Methods and Results-Forty-eight subjects (22 with manifest pulmonary hypertension, 13 with latent pulmonary hypertension, and 13 normal control subjects) underwent time-resolved 3D magnetic resonance phase-contrast imaging of the main pulmonary artery. Velocity fields that resulted from measurements were calculated, visualized, and analyzed with dedicated software. Main findings were as follows: (1) Manifest pulmonary hypertension coincides with the appearance of a vortex of blood flow in the main pulmonary artery (sensitivity and specificity of 1.00, 95% confidence intervals of 0.84 to 1.00 and 0.87 to 1.00, respectively), and (2) the relative period of existence of the vortex correlates significantly with mean pulmonary arterial pressure at rest (correlation coefficient of 0.94). To test the diagnostic performance of the vortex criterion, we furthermore investigated 55 patients in a blinded prospective study (22 with manifest pulmonary hypertension, 32 with latent pulmonary hypertension, and 1 healthy subject), which resulted in a sensitivity of 1.00 and specificity of 0.91 (95% confidence intervals of 0.84 to 1.00 and 0.76 to 0.98, respectively).Comparison of catheter-derived mean pulmonary artery pressure measurements and calculated mean pulmonary artery pressure values resulted in a standard deviation of differences of 3.6 mm Hg. Conclusions-Vortices

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“…In this connection, different hemodynamic parameters of pulmonary circulation such as mean, systolic, and diastolic pressures in the MPA have been studied by using focused echocardiographic Doppler examination (7,18). Also, magnetic resonance (MR) imaging has been used to assess significant variations in blood flow and cross-sectional areas (CSA) in the MPA of patients suffering from PAH compared with healthy volunteers (1,2,4,8,14,15). In particular, Mousseaux et al (14) have shown that velocity-encoded MR imaging could provide reliable measurements of cardiac output and of pulmonary vascular resistance.…”

mentioning

confidence: 99%

Noninvasive assessment of pulmonary arterial hypertension by MR phase-mapping method

Laffon¹,

Laurent

Bernard

et al. 2001

Journal of Applied Physiology

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Marthan. Noninvasive assessment of pulmonary arterial hypertension by MR phase-mapping method. J Appl Physiol 90: [2197][2198][2199][2200][2201][2202] 2001.-We describe a magnetic resonance (MR) imaging method that emphasizes pressure wave velocity to noninvasively assess pulmonary arterial hypertension. Both the blood flow and the corresponding vessel crosssectional area (CSA) were measured by MR phase mapping in the main pulmonary artery (MPA) in 15 patients. MPA pressures were also measured, in the same patients, by right-side heart catheterization. Two significant relationships were established: 1) between the pressure wave velocity in the MPA and the mean pressure in the MPA (Ppa) writing pressure wave velocity ϭ 9.25 Ppa Ϫ 202.51 (r ϭ 0.82) and 2) between the ratio of pressure wave velocity to the systolic blood velocity peak in the MPA (R) and the mean pressure in the MPA writing R ϭ 0.68 Ppa Ϫ 4.33 (r ϭ 0

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Pulmonary hypertension: pulmonary flow quantification and flow profile analysis with velocity-encoded cine MR imaging.

Cited by 153 publications

References 0 publications

Comprehensive Invasive and Noninvasive Approach to the Right Ventricle–Pulmonary Circulation Unit

Comprehensive Invasive and Noninvasive Approach to the Right Ventricle–Pulmonary Circulation Unit

Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure

Noninvasive assessment of pulmonary arterial hypertension by MR phase-mapping method

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