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European Radiology
Published in: European Radiology 4/2018

Open Access 01-04-2018 | Chest

Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging

Authors: C. S. Johns, S. Rajaram, D. A. Capener, C. Oram, C. Elliot, R. Condliffe, D. G. Kiely, J. M. Wild, A. J. Swift

Published in: European Radiology | Issue 4/2018

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Abstract

Purpose

Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models.

Methods

Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size.

Results

Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030).

Conclusion

CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis.

Key Points

• Pulmonary hypertension is a marker of poor outcome in COPD.
• MRI can predict invasively measured mean pulmonary artery pressure.
• Cardiac MRI allows for estimation of survival in COPD.
• Cardiac MRI may be useful for follow up or future trials.
• MRI is potentially useful to assess pulmonary hypertension in patients with COPD.
Literature
1.
Chaouat A, Naeije R, Weitzenblum E (2008) Pulmonary hypertension in COPD. Eur Respir J 32:1371–1385.CrossRefPubMed
2.
Wright JL (2005) Pulmonary hypertension in chronic obstructive pulmonary disease: current theories of pathogenesis and their implications for treatment. Thorax 60:605–609.CrossRefPubMedPubMedCentral
3.
Andersen KH, Iversen M, Kjaergaard J et al (2012) Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease. J Hear Lung Transplant 31:373–380.CrossRef
4.
Burrows B, Kettel LJ, Niden AH et al (1972) Patterns of Cardiovascular Dysfunction in Chronic Obstructive Lung Disease. N Engl J Med 286:912–918.CrossRefPubMed
5.
Cooper R, Ghali J, Simmons BE, Castaner A (1991) Elevated Pulmonary Artery Pressure. Chest 99:112–120.CrossRefPubMed
6.
Oswald-Mammosser M, Weitzenblum E, Quoix E et al (1995) Prognostic Factors in COPD Patients Receiving Long-term Oxygen Therapy: Importance of Pulmonary Artery Pressure. Chest 107:1193–1198.CrossRefPubMed
7.
Minai OA, Chaouat A, Adnot S (2010) Pulmonary Hypertension in COPD: Epidemiology, Significance, and Management. Chest 137:39S–51S.CrossRefPubMed
8.
Hyduk A, Croft JB, Ayala C et al (2005) Pulmonary hypertension surveillance--United States, 1980-2002. MMWR Surveill Summ 54:1–28PubMed
9.
Seeger W, Adir Y, Barberà JA et al (2013) Pulmonary Hypertension in Chronic Lung Diseases. J Am Coll Cardiol 62:D109–D116.CrossRefPubMed
10.
Boerrigter BG, Bogaard HJ, Trip P et al (2012) Ventilatory and Cardiocirculatory Exercise Profiles in COPD. Chest 142:1166–1174.CrossRefPubMed
11.
Hurdman J, Condliffe R, Elliot CA et al (2013) Pulmonary hypertension in COPD: results from the ASPIRE registry. Eur Respir J 41:1292–1301.CrossRefPubMed
12.
Hoeper MM, Lee SH, Voswinckel R et al (2006) Complications of Right Heart Catheterization Procedures in Patients With Pulmonary Hypertension in Experienced Centers. J Am Coll Cardiol 48:2546–2552.CrossRefPubMed
13.
Fisher MR, Criner GJ, Fishman AP et al (2007) Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J 30:914–921.CrossRefPubMed
14.
Arcasoy SM, Christie JD, Ferrari VA et al (2003) Echocardiographic Assessment of Pulmonary Hypertension in Patients with Advanced Lung Disease. Am J Respir Crit Care Med 167:735–740.CrossRefPubMed
15.
Swift AJ, Rajaram S, Hurdman J et al (2013) Noninvasive Estimation of PA Pressure, Flow, and Resistance With CMR Imaging. JACC Cardiovasc Imaging 6:1036–1047.CrossRefPubMed
16.
Swift A, Lungu A, Walker H, Capener D, Hammerton C, Elliot C, Condliffe R, Kiely D, Wild J (2015) Improved diagnostic accuracy of MRI in patients with suspected pulmonary hypertension with combined right ventricle and pulmonary artery metrics. ERS Int Congr 2015
17.
Moral S, Fernández-Friera L, Stevens G et al (2012) New index alpha improves detection of pulmonary hypertension in comparison with other cardiac magnetic resonance indices. Int J Cardiol 161:25–30.CrossRefPubMed
18.
Hurdman J, Condliffe R, Elliot CA et al (2012) ASPIRE registry: Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre. Eur Respir J 39:945–955.CrossRefPubMed
19.
Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 246:697–722.CrossRefPubMed
20.
Saba TS, Foster J, Cockburn M et al (2002) Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure. Eur Respir J 20:1519–1524.CrossRefPubMed
21.
Swift AJ, Rajaram S, Condliffe R et al (2012) Pulmonary artery relative area change detects mild elevations in pulmonary vascular resistance and predicts adverse outcome in pulmonary hypertension. Invest Radiol 47:571–577.CrossRefPubMed
22.
23.
Reiter G, Reiter U, Kovacs G et al (2015) Blood flow vortices along the main pulmonary artery measured with MR imaging for diagnosis of pulmonary hypertension. Radiology 275:71–79.CrossRefPubMed
24.
DeCamp MM, Lipson D, Krasna M et al (2008) The Evaluation and Preparation of the Patient for Lung Volume Reduction Surgery. Proc Am Thorac Soc 5:427–431.CrossRefPubMedPubMedCentral
25.
Meyers BF (2003) Chronic obstructive pulmonary disease * 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease. Thorax 58:634–638.CrossRefPubMedPubMedCentral
26.
Bauman G, Puderbach M, Deimling M et al (2009) Non-contrast-enhanced perfusion and ventilation assessment of the human lung by means of Fourier decomposition in proton MRI. Magn Reson Med 62:656–664.CrossRefPubMed
27.
Swift AJ, Wild JM, Fichele S et al (2005) Emphysematous changes and normal variation in smokers and COPD patients using diffusion 3He MRI. Eur J Radiol 54:352–358.CrossRefPubMed
Metadata
Title
Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging
Authors
C. S. Johns
S. Rajaram
D. A. Capener
C. Oram
C. Elliot
R. Condliffe
D. G. Kiely
J. M. Wild
A. J. Swift
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5143-y

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