Diagnostic Accuracy of Cardiovascular Magnetic Resonance Imaging of Right Ventricular Morphology and Function in the Assessment of Suspected Pulmonary Hypertension Results from the ASPIRE Registry

Overview

Journal J Cardiovasc Magn Reson

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
Radiology

Date 2012 Jun 23

PMID 22720870

Citations 46

Authors

Andrew J Swift

Smitha Rajaram

Robin Condliffe

Dave Capener

Judith Hurdman

Charlie A Elliot

Jim M Wild

David G Kiely

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular Magnetic Resonance (CMR) imaging is accurate and reproducible for the assessment of right ventricular (RV) morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH) in the assessment of patients with suspected PH in the clinic setting is not well described.

Methods: We retrospectively studied 233 consecutive treatment naïve patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC) within 48 hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP ≥ 25 mmHg was assessed using Fisher's exact test and receiver operating characteristic (ROC) analysis.

Results: Ventricular mass index (VMI) was the CMR measurement with the strongest correlation with mPAP (r = 0.78) and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91) compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI ≥ 0.4, retrograde flow ≥ 0.3 L/min/m² and PA relative area change ≤ 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH.

Conclusion: CMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension.

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References

Fisher M, Forfia P, Chamera E, Housten-Harris T, Champion H, Girgis R . Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009; 179(7):615-21. PMC: 2720125. DOI: 10.1164/rccm.200811-1691OC. View

Beygui F, Furber A, Delepine S, Helft G, Metzger J, Geslin P . Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study. Int J Cardiovasc Imaging. 2005; 20(6):509-16. DOI: 10.1007/s10554-004-1097-7. View

Mousseaux E, Tasu J, Jolivet O, Simonneau G, Bittoun J, Gaux J . Pulmonary arterial resistance: noninvasive measurement with indexes of pulmonary flow estimated at velocity-encoded MR imaging--preliminary experience. Radiology. 1999; 212(3):896-902. DOI: 10.1148/radiology.212.3.r99au21896. View

Lopez-Candales A, Bazaz R, Edelman K, Gulyasy B . Apical systolic eccentricity index: a better marker of right ventricular compromise in pulmonary hypertension. Echocardiography. 2010; 27(5):534-8. DOI: 10.1111/j.1540-8175.2009.01045.x. View

DAlonzo G, Barst R, Ayres S, Bergofsky E, Brundage B, Detre K . Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991; 115(5):343-9. DOI: 10.7326/0003-4819-115-5-343. View

Sanz J, Kuschnir P, Rius T, Salguero R, Sulica R, Einstein A . Pulmonary arterial hypertension: noninvasive detection with phase-contrast MR imaging. Radiology. 2007; 243(1):70-9. DOI: 10.1148/radiol.2431060477. View

Hagger D, Condliffe R, Woodhouse N, Elliot C, Armstrong I, Davies C . Ventricular mass index correlates with pulmonary artery pressure and predicts survival in suspected systemic sclerosis-associated pulmonary arterial hypertension. Rheumatology (Oxford). 2009; 48(9):1137-42. DOI: 10.1093/rheumatology/kep187. View

Galie N, Hoeper M, Humbert M, Torbicki A, Vachiery J, Barbera J . Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009; 34(6):1219-63. DOI: 10.1183/09031936.00139009. View

Kind T, Mauritz G, Marcus J, van de Veerdonk M, Westerhof N, Vonk-Noordegraaf A . Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson. 2010; 12:35. PMC: 2901360. DOI: 10.1186/1532-429X-12-35. View

10.

Arcasoy S, Christie J, Ferrari V, St John Sutton M, Zisman D, Blumenthal N . Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med. 2002; 167(5):735-40. DOI: 10.1164/rccm.200210-1130OC. View

11.

Sanz J, Kariisa M, Dellegrottaglie S, Prat-Gonzalez S, Garcia M, Fuster V . Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009; 2(3):286-95. DOI: 10.1016/j.jcmg.2008.08.007. View

12.

Schena M, Clini E, Errera D, Quadri A . Echo-Doppler evaluation of left ventricular impairment in chronic cor pulmonale. Chest. 1996; 109(6):1446-51. DOI: 10.1378/chest.109.6.1446. View

13.

Helderman F, Mauritz G, Andringa K, Vonk-Noordegraaf A, Marcus J . Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension. J Magn Reson Imaging. 2011; 33(6):1362-8. DOI: 10.1002/jmri.22581. View

14.

Humbert M, Sitbon O, Simonneau G . Treatment of pulmonary arterial hypertension. N Engl J Med. 2004; 351(14):1425-36. DOI: 10.1056/NEJMra040291. View

15.

Jardim C, Rochitte C, Humbert M, Rubenfeld G, Jasinowodolinski D, Carvalho C . Pulmonary artery distensibility in pulmonary arterial hypertension: an MRI pilot study. Eur Respir J. 2006; 29(3):476-81. DOI: 10.1183/09031936.00016806. View

16.

Fisher M, Criner G, Fishman A, Hassoun P, Minai O, Scharf S . Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J. 2007; 30(5):914-21. DOI: 10.1183/09031936.00033007. View

17.

Kuehne T, Yilmaz S, Steendijk P, Moore P, Groenink M, Saaed M . Magnetic resonance imaging analysis of right ventricular pressure-volume loops: in vivo validation and clinical application in patients with pulmonary hypertension. Circulation. 2004; 110(14):2010-6. DOI: 10.1161/01.CIR.0000143138.02493.DD. View

18.

Blyth K, Groenning B, Martin T, Foster J, Mark P, Dargie H . Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension. Eur Heart J. 2005; 26(19):1993-9. DOI: 10.1093/eurheartj/ehi328. View

19.

Lopez-Candales A, Rajagopalan N, Kochar M, Gulyasy B, Edelman K . Systolic eccentricity index identifies right ventricular dysfunction in pulmonary hypertension. Int J Cardiol. 2007; 129(3):424-6. DOI: 10.1016/j.ijcard.2007.06.057. View

20.

Galie N, Hoeper M, Humbert M, Torbicki A, Vachiery J, Barbera J . Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the.... Eur Heart J. 2009; 30(20):2493-537. DOI: 10.1093/eurheartj/ehp297. View