Advanced Imaging Tools Rather Than Hemodynamics Should Be the Primary Approach for Diagnosing, Following, and Managing Pulmonary Arterial Hypertension

Overview

Journal Can J Cardiol

Publisher Elsevier

Specialty Cardiology & Vascular Diseases

Date 2015 Apr 4

PMID 25840101

Citations 9

Authors

Mario Gerges

Christian Gerges

Irene M Lang

Affiliations

Soon will be listed here.

Abstract

Pulmonary hypertension (PH) is currently defined based on invasive measurements: a resting pulmonary artery pressure ≥ 25 mm Hg. For pulmonary arterial hypertension, a pulmonary arterial wedge pressure ≤ 15 mm Hg and pulmonary vascular resistance > 3 Wood units are also required. Thus, right heart catheterization is inevitable at present. However, the diagnosis, follow-up, and management of PH by noninvasive techniques is progressing. Significant advances have been achieved in the imaging of pulmonary vascular disease and the right ventricle. We review the current sensitivities and specificities of noninvasive imaging of PH and discuss its role and future potential to replace hemodynamics as the primary approach to screening, diagnosing, and following/managing PH.

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References

Hsu V, Moreyra A, Wilson A, Shinnar M, Shindler D, Wilson J . Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization. J Rheumatol. 2008; 35(3):458-65. View

McLaughlin V, Archer S, Badesch D, Barst R, Farber H, Mathier M . ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American.... Circulation. 2009; 119(16):2250-94. DOI: 10.1161/CIRCULATIONAHA.109.192230. View

Halpern S, Taichman D . Misclassification of pulmonary hypertension due to reliance on pulmonary capillary wedge pressure rather than left ventricular end-diastolic pressure. Chest. 2009; 136(1):37-43. DOI: 10.1378/chest.08-2784. View

Nogami M, Ohno Y, Koyama H, Kono A, Takenaka D, Kataoka T . Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: comparison with right heart catheterization and echocardiography. J Magn Reson Imaging. 2009; 30(5):973-80. DOI: 10.1002/jmri.21935. 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

Ghio S, Klersy C, Magrini G, DArmini A, Scelsi L, Raineri C . Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2008; 140(3):272-8. DOI: 10.1016/j.ijcard.2008.11.051. View

Meris A, Faletra F, Conca C, Klersy C, Regoli F, Klimusina J . Timing and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr. 2010; 23(8):823-31. DOI: 10.1016/j.echo.2010.05.009. View

Dahiya A, Vollbon W, Jellis C, Prior D, Wahi S, Marwick T . Echocardiographic assessment of raised pulmonary vascular resistance: application to diagnosis and follow-up of pulmonary hypertension. Heart. 2010; 96(24):2005-9. DOI: 10.1136/hrt.2010.204834. View

Mehta S, Helmersen D, Provencher S, Hirani N, Rubens F, de Perrot M . Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: a clinical practice guideline. Can Respir J. 2010; 17(6):301-34. PMC: 3006154. DOI: 10.1155/2010/704258. View

10.

Lang I, Plank C, Sadushi-Kolici R, Jakowitsch J, Klepetko W, Maurer G . Imaging in pulmonary hypertension. JACC Cardiovasc Imaging. 2010; 3(12):1287-95. DOI: 10.1016/j.jcmg.2010.09.013. View

11.

Ghio S, Pazzano A, Klersy C, Scelsi L, Raineri C, Camporotondo R . Clinical and prognostic relevance of echocardiographic evaluation of right ventricular geometry in patients with idiopathic pulmonary arterial hypertension. Am J Cardiol. 2010; 107(4):628-32. DOI: 10.1016/j.amjcard.2010.10.027. View

12.

Hoey E, Mirsadraee S, Pepke-Zaba J, Jenkins D, Gopalan D, Screaton N . Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience. AJR Am J Roentgenol. 2011; 196(3):524-32. DOI: 10.2214/AJR.10.4842. View

13.

Chan A, Juarez M, Shelton D, MacDonald T, Li C, Lin T . Novel computed tomographic chest metrics to detect pulmonary hypertension. BMC Med Imaging. 2011; 11:7. PMC: 3073886. DOI: 10.1186/1471-2342-11-7. View

14.

Jaff M, McMurtry M, Archer S, Cushman M, Goldenberg N, Goldhaber S . Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123(16):1788-830. DOI: 10.1161/CIR.0b013e318214914f. View

15.

van Wolferen S, van de Veerdonk M, Mauritz G, Jacobs W, Marcus J, Marques K . Clinically significant change in stroke volume in pulmonary hypertension. Chest. 2010; 139(5):1003-1009. DOI: 10.1378/chest.10-1066. View

16.

Parent F, Bachir D, Inamo J, Lionnet F, Driss F, Loko G . A hemodynamic study of pulmonary hypertension in sickle cell disease. N Engl J Med. 2011; 365(1):44-53. DOI: 10.1056/NEJMoa1005565. View

17.

Moledina S, de Bruyn A, Schievano S, Owens C, Young C, Haworth S . Fractal branching quantifies vascular changes and predicts survival in pulmonary hypertension: a proof of principle study. Heart. 2011; 97(15):1245-9. DOI: 10.1136/hrt.2010.214130. View

18.

van de Veerdonk M, Kind T, Marcus J, Mauritz G, Heymans M, Bogaard H . Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol. 2011; 58(24):2511-9. DOI: 10.1016/j.jacc.2011.06.068. View

19.

Wilkens H, Lang I, Behr J, Berghaus T, Grohe C, Guth S . Chronic thromboembolic pulmonary hypertension (CTEPH): updated Recommendations of the Cologne Consensus Conference 2011. Int J Cardiol. 2012; 154 Suppl 1:S54-60. DOI: 10.1016/S0167-5273(11)70493-4. View

20.

Ley S, Ley-Zaporozhan J, Pitton M, Schneider J, Wirth G, Mayer E . Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol. 2011; 22(3):607-16. DOI: 10.1007/s00330-011-2290-4. View