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Current Heart Failure Reports

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Open Access 01-10-2020 | Magnetic Resonance Imaging | Imaging in Heart Failure (J Schulz-Menger, Section Editor)

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Authors: Barbro Kjellström, Anthony Lindholm, Ellen Ostenfeld

Published in: Current Heart Failure Reports | Issue 5/2020

Abstract

Purpose of Review

Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH.

Recent Findings

New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling.

Summary

CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH.

Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint 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: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119.PubMed

Augustine DX, Coates-Bradshaw LD, Willis J, Harkness A, Ring L, Grapsa J, et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2018;5(3):G11–24.PubMedPubMedCentral

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63.PubMed

Ostenfeld E, Flachskampf FA. Assessment of right ventricular volumes and ejection fraction by echocardiography: from geometric approximations to realistic shapes. Echo Res Pract. 2015;2(1):R1–R11.PubMedPubMedCentral

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713 quiz 86-8.PubMed

Benza R, Biederman R, Murali S, Gupta H. Role of cardiac magnetic resonance imaging in the management of patients with pulmonary arterial hypertension. J Am Coll Cardiol. 2008;52(21):1683–92.PubMed

Jensen AS, Broberg CS, Rydman R, Diller GP, Li W, Dimopoulos K, et al. Impaired right, left, or biventricular function and resting oxygen saturation are associated with mortality in Eisenmenger syndrome: a clinical and cardiovascular magnetic resonance study. Circ Cardiovasc Imaging. 2015;8(12):e003596.

Freed BH, Gomberg-Maitland M, Chandra S, Mor-Avi V, Rich S, Archer SL, et al. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension. J Cardiovasc Magn Reson. 2012;14:11.PubMedPubMedCentral

Sato T, Tsujino I, Ohira H, Oyama-Manabe N, Ito YM, Yamada A, et al. Right atrial volume and reservoir function are novel independent predictors of clinical worsening in patients with pulmonary hypertension. J Heart Lung Transplant. 2015;34(3):414–23.PubMed

10.

Yamada Y, Okuda S, Kataoka M, Tanimoto A, Tamura Y, Abe T, et al. Prognostic value of cardiac magnetic resonance imaging for idiopathic pulmonary arterial hypertension before initiating intravenous prostacyclin therapy. Circ J. 2012;76(7):1737–43.PubMed

11.

Baggen VJ, Leiner T, Post MC, van Dijk AP, Roos-Hesselink JW, Boersma E, et al. Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis. Eur Radiol. 2016;26(11):3771–80.PubMedPubMedCentral

12.

•• Dong Y, Pan Z, Wang D, Lv J, Fang J, Xu R, et al. Prognostic value of cardiac magnetic resonance derived right ventricular remodeling parameters in pulmonary hypertension: a systematic review and meta-analysis. Circ Cardiovasc Imaging. 2020;13(7):e010568. A systematic review of right ventricular remodelling and outcome that put the pathophysiology in the context of different etiologies.

13.

Grapsa J, Tan TC, Nunes MCP, O'Regan DP, Durighel G, Howard L, et al. Prognostic impact of right ventricular mass change in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2020;304:172–4.PubMed

14.

van Wolferen SA, Marcus JT, Boonstra A, Marques KM, Bronzwaer JG, Spreeuwenberg MD, et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J. 2007;28(10):1250–7.PubMed

15.

Benza RL, Gomberg-Maitland M, Elliott CG, Farber HW, Foreman AJ, Frost AE, et al. Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies. Chest. 2019;156(2):323–37.PubMed

16.

•• Lewis RA, Johns CS, Cogliano M, Capener D, Tubman E, Elliot CA, et al. Identification of cardiac magnetic resonance imaging thresholds for risk stratification in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2020;201(4):458–68 Important contribution highlighting the added value of CMR over current prognostic methods.PubMed

17.

• Bredfelt A, Radegran G, Hesselstrand R, Arheden H, Ostenfeld E. Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre-capillary pulmonary hypertension. ESC Heart Fail. 2018;5(5):864–75 Important contribution highlighting the role of the right atrium in prognosis.PubMedPubMedCentral

18.

Corona-Villalobos CP, Kamel IR, Rastegar N, Damico R, Kolb TM, Boyce DM, et al. Bidimensional measurements of right ventricular function for prediction of survival in patients with pulmonary hypertension: comparison of reproducibility and time of analysis with volumetric cardiac magnetic resonance imaging analysis. Pulm Circ. 2015;5(3):527–37.PubMedPubMedCentral

19.

Hedstrom E, Bredfelt A, Radegran G, Arheden H, Ostenfeld E. Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization. ESC Heart Fail. 2020;7:1653–63.PubMedPubMedCentral

20.

Leng S, Dong Y, Wu Y, Zhao X, Ruan W, Zhang G, et al. Impaired cardiovascular magnetic resonance-derived rapid semiautomated right atrial longitudinal strain is associated with decompensated hemodynamics in pulmonary arterial hypertension. Circ Cardiovasc Imaging. 2019;12(5):e008582.PubMed

21.

•• Sato T, Ambale-Venkatesh B, Lima JAC, Zimmerman SL, Tedford RJ, Fujii T, et al. The impact of ambrisentan and tadalafil upfront combination therapy on cardiac function in scleroderma associated pulmonary arterial hypertension patients: cardiac magnetic resonance feature tracking study. Pulm Circ. 2018;8(1):2045893217748307 Important contribution on the utility of CMR and strain in treatment follow-up.PubMed

22.

Grapsa J, Gibbs JS, Cabrita IZ, Watson GF, Pavlopoulos H, Dawson D, et al. The association of clinical outcome with right atrial and ventricular remodelling in patients with pulmonary arterial hypertension: study with real-time three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13(8):666–72.PubMed

23.

Seemann F, Baldassarre LA, Llanos-Chea F, Gonzales RA, Grunseich K, Hu C, et al. Assessment of diastolic function and atrial remodeling by MRI—validation and correlation with echocardiography and filling pressure. Physiol Rep. 2018;6(17):e13828.PubMedPubMedCentral

24.

Marston NA, Auger WR, Madani MM, Kimura BJ, Strachan GM, Raisinghani AB, et al. Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension. Cardiovasc Ultrasound. 2014;12:32.PubMedPubMedCentral

25.

Motoji Y, Tanaka H, Fukuda Y, Sano H, Ryo K, Imanishi J, et al. Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension. Int J Cardiovasc Imaging. 2015;31(4):691–8.PubMed

26.

Zou H, Leng S, Xi C, Zhao X, Koh AS, Gao F, et al. Three-dimensional biventricular strains in pulmonary arterial hypertension patients using hyperelastic warping. Comput Methods Prog Biomed. 2020;189:105345.

27.

Kallianos K, Brooks GC, Mukai K, Seguro de Carvalho F, Liu J, Naeger DM, et al. Cardiac magnetic resonance evaluation of left ventricular myocardial strain in pulmonary hypertension. Acad Radiol. 2018;25(1):129–35.PubMed

28.

de Siqueira ME, Pozo E, Fernandes VR, Sengupta PP, Modesto K, Gupta SS, et al. Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking. J Cardiovasc Magn Reson. 2016;18(1):39.PubMedPubMedCentral

29.

Lindholm A, Hesselstrand R, Radegran G, Arheden H, Ostenfeld E. Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se. Clin Physiol Funct Imaging. 2019;39(3):215–25.

30.

Seemann F, Pahlm U, Steding-Ehrenborg K, Ostenfeld E, Erlinge D, Dubois-Rande JL, et al. Time-resolved tracking of the atrioventricular plane displacement in cardiovascular magnetic resonance (CMR) images. BMC Med Imaging. 2017;17(1):19.PubMedPubMedCentral

31.

Ostenfeld E, Stephensen SS, Steding-Ehrenborg K, Heiberg E, Arheden H, Radegran G, et al. Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension. Int J Cardiovasc Imaging. 2016;32:1243–53.PubMed

32.

Evaldsson AW, Lindholm A, Jumatate R, Ingvarsson A, Smith GJ, Waktare J, et al. Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance. BMC Cardiovasc Disord. 2020;20(1):259.PubMedPubMedCentral

33.

Frank BS, Schafer M, Douwes JM, Ivy DD, Abman SH, Davidson JA, et al. Novel measures of left ventricular electromechanical discoordination predict clinical outcomes in children with pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol. 2020;318(2):H401–H12.PubMed

34.

Marcus JT, Gan CT, Zwanenburg JJ, Boonstra A, Allaart CP, Gotte MJ, et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol. 2008;51(7):750–7.PubMed

35.

Marcus JT, Mauritz GJ, Kind T, Vonk-Noordegraaf A. Interventricular mechanical dyssynchrony in pulmonary arterial hypertension: early or delayed strain in the right ventricular free wall? Am J Cardiol. 2009;103(6):894–5.PubMed

36.

Schafer M, Collins KK, Browne LP, Ivy DD, Abman S, Friesen R, et al. Effect of electrical dyssynchrony on left and right ventricular mechanics in children with pulmonary arterial hypertension. J Heart Lung Transplant. 2018;37(7):870–8.PubMed

37.

Hoette S, Creuze N, Gunther S, Montani D, Savale L, Jais X, et al. RV fractional area change and TAPSE as predictors of severe right ventricular dysfunction in pulmonary hypertension: a CMR study. Lung. 2018;196(2):157–64.PubMed

38.

Blyth KG, Groenning BA, Martin TN, Foster JE, Mark PB, Dargie HJ, et al. Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension. Eur Heart J. 2005;26(19):1993–9.PubMed

39.

McCann GP, Beek AM, Vonk-Noordegraaf A, van Rossum AC. Delayed contrast-enhanced magnetic resonance imaging in pulmonary arterial hypertension. Circulation. 2005;112(16):e268.PubMed

40.

Sanz J, Dellegrottaglie S, Kariisa M, Sulica R, Poon M, O'Donnell TP, et al. Prevalence and correlates of septal delayed contrast enhancement in patients with pulmonary hypertension. Am J Cardiol. 2007;100(4):731–5.PubMed

41.

Swift AJ, Rajaram S, Capener D, Elliot C, Condliffe R, Wild JM, et al. LGE patterns in pulmonary hypertension do not impact overall mortality. JACC Cardiovasc Imaging. 2014;7(12):1209–17.PubMed

42.

Broberg CS, Prasad SK, Carr C, Babu-Narayan SV, Dimopoulos K, Gatzoulis MA. Myocardial fibrosis in Eisenmenger syndrome: a descriptive cohort study exploring associations of late gadolinium enhancement with clinical status and survival. J Cardiovasc Magn Reson. 2014;16:32.PubMedPubMedCentral

43.

Ntusi NA, Piechnik SK, Francis JM, Ferreira VM, Rai AB, Matthews PM, et al. Subclinical myocardial inflammation and diffuse fibrosis are common in systemic sclerosis—a clinical study using myocardial T1-mapping and extracellular volume quantification. J Cardiovasc Magn Reson. 2014;16:21.PubMedPubMedCentral

44.

Bratis K, Lindholm A, Hesselstrand R, Arheden H, Karabela G, Stavropoulos E, et al. CMR feature tracking in cardiac asymptomatic systemic sclerosis: clinical implications. PLoS One. 2019;14(8):e0221021.PubMedPubMedCentral

45.

Mavrogeni SI, Bratis K, Karabela G, Spiliotis G, Wijk K, Hautemann D, et al. Cardiovascular magnetic resonance imaging clarifies cardiac pathophysiology in early, asymptomatic diffuse systemic sclerosis. Inflamm Allergy Drug Targets. 2015;14(1):29–36.PubMed

46.

Hromadka M, Seidlerova J, Suchy D, Rajdl D, Lhotsky J, Ludvik J, et al. Myocardial fibrosis detected by magnetic resonance in systemic sclerosis patients—relationship with biochemical and echocardiography parameters. Int J Cardiol. 2017;249:448–53.PubMed

47.

Kanski M, Arheden H, Wuttge DM, Bozovic G, Hesselstrand R, Ugander M. Pulmonary blood volume indexed to lung volume is reduced in newly diagnosed systemic sclerosis compared to normals—a prospective clinical cardiovascular magnetic resonance study addressing pulmonary vascular changes. J Cardiovasc Magn Reson. 2013;15:86.PubMedPubMedCentral

48.

Kobayashi H, Yokoe I, Hirano M, Nakamura T, Nakajima Y, Fontaine KR, et al. Cardiac magnetic resonance imaging with pharmacological stress perfusion and delayed enhancement in asymptomatic patients with systemic sclerosis. J Rheumatol. 2009;36(1):106–12.PubMed

49.

Kellman P, Wilson JR, Xue H, Bandettini WP, Shanbhag SM, Druey KM, et al. Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience. J Cardiovasc Magn Reson. 2012;14:64.PubMedPubMedCentral

50.

Kellman P, Wilson JR, Xue H, Ugander M, Arai AE. Extracellular volume fraction mapping in the myocardium, part 1: evaluation of an automated method. J Cardiovasc Magn Reson. 2012;14:63.PubMedPubMedCentral

51.

Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P, et al. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson. 2017;19(1):75.PubMedPubMedCentral

52.

Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P, et al. Correction to: clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson. 2018;20(1):9.PubMedPubMedCentral

53.

Ugander M, Oki AJ, Hsu LY, Kellman P, Greiser A, Aletras AH, et al. Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J. 2012;33(10):1268–78.PubMedPubMedCentral

54.

Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Choudhury RP, et al. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:42.PubMedPubMedCentral

55.

Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Ntusi N, et al. T(1) mapping for the diagnosis of acute myocarditis using CMR: comparison to T2-weighted and late gadolinium enhanced imaging. JACC Cardiovasc Imaging. 2013;6(10):1048–58.PubMed

56.

Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, et al. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013;15:92.PubMedPubMedCentral

57.

Homsi R, Luetkens JA, Skowasch D, Pizarro C, Sprinkart AM, Gieseke J, et al. Left ventricular myocardial fibrosis, atrophy, and impaired contractility in patients with pulmonary arterial hypertension and a preserved left ventricular function: a cardiac magnetic resonance study. J Thorac Imaging. 2017;32(1):36–42.PubMed

58.

Mehta BB, Auger DA, Gonzalez JA, Workman V, Chen X, Chow K, et al. Detection of elevated right ventricular extracellular volume in pulmonary hypertension using Accelerated and Navigator-Gated Look-Locker Imaging for Cardiac T1 Estimation (ANGIE) cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2015;17:110.PubMedPubMedCentral

59.

Roller FC, Wiedenroth C, Breithecker A, Liebetrau C, Mayer E, Schneider C, et al. Native T1 mapping and extracellular volume fraction measurement for assessment of right ventricular insertion point and septal fibrosis in chronic thromboembolic pulmonary hypertension. Eur Radiol. 2017;27(5):1980–91.PubMed

60.

Spruijt OA, Vissers L, Bogaard HJ, Hofman MB, Vonk-Noordegraaf A, Marcus JT. Increased native T1-values at the interventricular insertion regions in precapillary pulmonary hypertension. Int J Cardiovasc Imaging. 2016;32(3):451–9.PubMed

61.

Chen YY, Yun H, Jin H, Kong H, Long YL, Fu CX, et al. Association of native T1 times with biventricular function and hemodynamics in precapillary pulmonary hypertension. Int J Cardiovasc Imaging. 2017;33(8):1179–89.PubMed

62.

Reiter U, Reiter G, Kovacs G, Adelsmayr G, Greiser A, Olschewski H, et al. Native myocardial T1 mapping in pulmonary hypertension: correlations with cardiac function and hemodynamics. Eur Radiol. 2017;27(1):157–66.PubMed

63.

Saunders LC, Johns CS, Stewart NJ, Oram CJE, Capener DA, Puntmann VO, et al. Diagnostic and prognostic significance of cardiovascular magnetic resonance native myocardial T1 mapping in patients with pulmonary hypertension. J Cardiovasc Magn Reson. 2018;20(1):78.PubMedPubMedCentral

64.

Jankowich M, Abbasi SA, Vang A, Choudhary G. Right ventricular fibrosis is related to pulmonary artery stiffness in pulmonary hypertension: a cardiac magnetic resonance imaging study. Am J Respir Crit Care Med. 2019;200(6):776–9.PubMed

65.

Nitsche C, Kammerlander AA, Binder C, Duca F, Aschauer S, Koschutnik M, et al. Native T1 time of right ventricular insertion points by cardiac magnetic resonance: relation with invasive haemodynamics and outcome in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging. 2020;21(6):683–91.PubMed

66.

Wang J, Zhao H, Wang Y, Herrmann HC, Witschey WRT, Han Y. Native T1 and T2 mapping by cardiovascular magnetic resonance imaging in pressure overloaded left and right heart diseases. J Thorac Dis. 2018;10(5):2968–75.PubMedPubMedCentral

67.

Pagano JJ, Chow K, Khan A, Michelakis E, Paterson I, Oudit GY, et al. Reduced right ventricular native myocardial T1 in Anderson-Fabry disease: comparison to pulmonary hypertension and healthy controls. PLoS One. 2016;11(6):e0157565.PubMedPubMedCentral

68.

Patel RB, Li E, Benefield BC, Swat SA, Polsinelli VB, Carr JC, et al. Diffuse right ventricular fibrosis in heart failure with preserved ejection fraction and pulmonary hypertension. ESC Heart Fail. 2020;7(1):253–63.PubMedPubMedCentral

69.

Kellman P, Hansen MS. T1-mapping in the heart: accuracy and precision. J Cardiovasc Magn Reson. 2014;16:2.PubMedPubMedCentral

70.

Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1):1801913.

71.

Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol. 2006;48(12):2546–52.PubMed

72.

Johns CS, Kiely DG, Rajaram S, Hill C, Thomas S, Karunasaagarar K, et al. Diagnosis of pulmonary hypertension with cardiac MRI: derivation and validation of regression models. Radiology. 2019;290(1):61–8.PubMed

73.

Meyer GMB, Spilimbergo FB, Altmayer S, Pacini GS, Zanon M, Watte G, et al. Multiparametric magnetic resonance imaging in the assessment of pulmonary hypertension: initial experience of a one-stop study. Lung. 2018;196(2):165–71.PubMed

74.

Swift AJ, Rajaram S, Hurdman J, Hill C, Davies C, Sproson TW, et al. Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging: derivation and prospective validation study from the ASPIRE registry. JACC Cardiovasc Imaging. 2013;6(10):1036–47.PubMed

75.

Moral S, Fernandez-Friera L, Stevens G, Guzman G, Garcia-Alvarez A, Nair A, et al. New index alpha improves detection of pulmonary hypertension in comparison with other cardiac magnetic resonance indices. Int J Cardiol. 2012;161(1):25–30.PubMed

76.

Chin KM, Kim NH, Rubin LJ. The right ventricle in pulmonary hypertension. Coron Artery Dis. 2005;16(1):13–8.PubMed

77.

Vonk Noordegraaf A, Chin KM, Haddad F, Hassoun PM, Hemnes AR, Hopkins SR, et al. Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: an update. Eur Respir J. 2019;53(1):1801900.

78.

Klima UP, Lee MY, Guerrero JL, Laraia PJ, Levine RA, Vlahakes GJ. Determinants of maximal right ventricular function: role of septal shift. J Thorac Cardiovasc Surg. 2002;123(1):72–80.PubMed

79.

Roeleveld RJ, Marcus JT, Faes TJ, Gan TJ, Boonstra A, Postmus PE, et al. Interventricular septal configuration at MR imaging and pulmonary arterial pressure in pulmonary hypertension. Radiology. 2005;234(3):710–7.PubMed

80.

Mouratoglou SA, Kallifatidis A, Pitsiou G, Grosomanidis V, Kamperidis V, Chalikias G, et al. Duration of interventricular septal shift toward the left ventricle is associated with poor clinical outcome in precapillary pulmonary hypertension: a cardiac magnetic resonance study. Hell J Cardiol. 2018;30:S1109-9666(18)30367-1.

81.

•• Ramos JG, Fyrdahl A, Wieslander B, Reiter G, Reiter U, Jin N, et al. Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure. BMC Med Imaging. 2020;20(1):28 Detailed description and test of a non-invasive method to estimate mean pulmonary pressure. An important step towards a non-invasive diagnosis of PH with high accuracy.PubMedPubMedCentral

82.

Reiter U, Reiter G, Kovacs G, Stalder AF, Gulsun MA, Greiser A, et al. Evaluation of elevated mean pulmonary arterial pressure based on magnetic resonance 4D velocity mapping: comparison of visualization techniques. PLoS One. 2013;8(12):e82212.PubMedPubMedCentral

83.

Reiter G, Reiter U, Kovacs G, Adelsmayr G, Greiser A, Stalder AF, et al. Counter-clockwise vortical blood flow in the main pulmonary artery in a patient with patent ductus arteriosus with pulmonary arterial hypertension: a cardiac magnetic resonance imaging case report. BMC Med Imaging. 2016;16(1):45.PubMedPubMedCentral

84.

Reiter G, Reiter U, Kovacs G, Kainz B, Schmidt K, Maier R, et al. 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. Circ Cardiovasc Imaging. 2008;1(1):23–30.PubMed

85.

Reiter G, Reiter U, Kovacs G, Olschewski H, Fuchsjager M. Blood flow vortices along the main pulmonary artery measured with MR imaging for diagnosis of pulmonary hypertension. Radiology. 2015;275(1):71–9.PubMed

86.

Elbaz MS, Calkoen EE, Westenberg JJ, Lelieveldt BP, Roest AA, van der Geest RJ. Vortex flow during early and late left ventricular filling in normal subjects: quantitative characterization using retrospectively-gated 4D flow cardiovascular magnetic resonance and three-dimensional vortex core analysis. J Cardiovasc Magn Reson. 2014;16:78.PubMedPubMedCentral

87.

Toger J, Kanski M, Carlsson M, Kovacs SJ, Soderlind G, Arheden H, et al. Vortex ring formation in the left ventricle of the heart: analysis by 4D flow MRI and Lagrangian coherent structures. Ann Biomed Eng. 2012;40(12):2652–62.PubMed

88.

Arvidsson PM, Kovacs SJ, Toger J, Borgquist R, Heiberg E, Carlsson M, et al. Vortex ring behavior provides the epigenetic blueprint for the human heart. Sci Rep. 2016;6:22021.PubMedPubMedCentral

89.

Toger J, Kanski M, Arvidsson PM, Carlsson M, Kovacs SJ, Borgquist R, et al. Vortex-ring mixing as a measure of diastolic function of the human heart: phantom validation and initial observations in healthy volunteers and patients with heart failure. J Magn Reson Imaging. 2016;43(6):1386–97.PubMed

90.

Yan C, Xu Z, Jin J, Lv J, Liu Q, Zhu Z, et al. A feasible method for non-invasive measurement of pulmonary vascular resistance in pulmonary arterial hypertension: combined use of transthoracic Doppler-echocardiography and cardiac magnetic resonance. Non-invasive estimation of pulmonary vascular resistance. Int J Cardiol Heart Vasc. 2015;9:22–7.PubMedPubMedCentral

91.

Muthurangu V, Taylor A, Andriantsimiavona R, Hegde S, Miquel ME, Tulloh R, et al. Novel method of quantifying pulmonary vascular resistance by use of simultaneous invasive pressure monitoring and phase-contrast magnetic resonance flow. Circulation. 2004;110(7):826–34.PubMed

92.

Garcia-Alvarez A, Fernandez-Friera L, Mirelis JG, Sawit S, Nair A, Kallman J, et al. Non-invasive estimation of pulmonary vascular resistance with cardiac magnetic resonance. Eur Heart J. 2011;32(19):2438–45.PubMed

93.

Bane O, Shah SJ, Cuttica MJ, Collins JD, Selvaraj S, Chatterjee NR, et al. A non-invasive assessment of cardiopulmonary hemodynamics with MRI in pulmonary hypertension. Magn Reson Imaging. 2015;33(10):1224–35.PubMedPubMedCentral

94.

Rogers T, Ratnayaka K, Khan JM, Stine A, Schenke WH, Grant LP, et al. CMR fluoroscopy right heart catheterization for cardiac output and pulmonary vascular resistance: results in 102 patients. J Cardiovasc Magn Reson. 2017;19(1):54.PubMedPubMedCentral

95.

Chen H, Xiang B, Zeng J, Luo H, Yang Q. The feasibility in estimating pulmonary vascular resistance by cardiovascular magnetic resonance in pulmonary hypertension: a systematic review and meta-analysis. Eur J Radiol. 2019;114:137–45.PubMed

96.

Bogren HG, Klipstein RH, Mohiaddin RH, Firmin DN, Underwood SR, Rees RS, et al. Pulmonary artery distensibility and blood flow patterns: a magnetic resonance study of normal subjects and of patients with pulmonary arterial hypertension. Am Heart J. 1989;118(5 Pt 1):990–9.PubMed

97.

Sanz J, Kariisa M, Dellegrottaglie S, Prat-Gonzalez S, Garcia MJ, Fuster V, et al. Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009;2(3):286–95.PubMed

98.

Agoston-Coldea L, Lupu S, Mocan T. Pulmonary artery stiffness by cardiac magnetic resonance imaging predicts major adverse cardiovascular events in patients with chronic obstructive pulmonary disease. Sci Rep. 2018;8(1):14447.PubMedPubMedCentral

99.

Swift AJ, Capener D, Johns C, Hamilton N, Rothman A, Elliot C, et al. Magnetic resonance imaging in the prognostic evaluation of patients with pulmonary arterial hypertension. Am J Respir Crit Care Med. 2017;196(2):228–39.PubMedPubMedCentral

100.

Malhotra R, Dhakal BP, Eisman AS, Pappagianopoulos PP, Dress A, Weiner RB, et al. Pulmonary vascular distensibility predicts pulmonary hypertension severity, exercise capacity, and survival in heart failure. Circ Heart Fail. Circ Heart Fail. 2016;9(6):10.1161.

101.

Singh I, Oliveira RKF, Naeije R, Rahaghi FN, Oldham WM, Systrom DM, et al. Pulmonary vascular distensibility and early pulmonary vascular remodeling in pulmonary hypertension. Chest. 2019;156(4):724–32.PubMed

102.

• Gupta A, Sharifov OF, Lloyd SG, Tallaj JA, Aban I, Dell'italia LJ, et al. Novel noninvasive assessment of pulmonary arterial stiffness using velocity transfer function. J Am Heart Assoc. 2018;7(18):e009459 New measure that adds to understanding PA stiffness in PAH.PubMedPubMedCentral

103.

Hjalmarsson C, Radegran G, Kylhammar D, Rundqvist B, Multing J, Nisell MD, et al. Impact of age and comorbidity on risk stratification in idiopathic pulmonary arterial hypertension. Eur Respir J. 2018;51(5):1702310.

104.

Sanz J, Garcia-Alvarez A, Fernandez-Friera L, Nair A, Mirelis JG, Sawit ST, et al. Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study. Heart. 2012;98(3):238–43.PubMed

105.

Mynard JP, Smolich JJ. One-dimensional haemodynamic modeling and wave dynamics in the entire adult circulation. Ann Biomed Eng. 2015;43(6):1443–60.PubMed

106.

Dell'Italia LJ, Walsh RA. Application of a time varying elastance model to right ventricular performance in man. Cardiovasc Res. 1988;22(12):864–74.PubMed

107.

Trip P, Kind T, van de Veerdonk MC, Marcus JT, de Man FS, Westerhof N, et al. Accurate assessment of load-independent right ventricular systolic function in patients with pulmonary hypertension. J Heart Lung Transplant. 2013;32(1):50–5.PubMed

108.

Hsu S. Coupling right ventricular-pulmonary arterial research to the pulmonary hypertension patient bedside. Circ Heart Fail. 2019;12(1):e005715.PubMed

109.

• Hsu S, Simpson CE, Houston BA, Wand A, Sato T, Kolb TM, et al. Multi-beat right ventricular-arterial coupling predicts clinical worsening in pulmonary arterial hypertension. J Am Heart Assoc. 2020;9(10):e016031 Brings the understanding of the importance of RV-PA coupling in PAH a step further.PubMed

110.

• Inuzuka R, Hsu S, Tedford RJ, Senzaki H. Single-beat estimation of right ventricular contractility and its coupling to pulmonary arterial load in patients with pulmonary hypertension. J Am Heart Assoc. 2018;7(10):e007929. Introduces a new method for assessing RV-PA coupling in PAH.

111.

Brewis MJ, Bellofiore A, Vanderpool RR, Chesler NC, Johnson MK, Naeije R, et al. Imaging right ventricular function to predict outcome in pulmonary arterial hypertension. Int J Cardiol. 2016;218:206–11.PubMedPubMedCentral

112.

Tello K, Dalmer A, Axmann J, Vanderpool R, Ghofrani HA, Naeije R, et al. Reserve of right ventricular-arterial coupling in the setting of chronic overload. Circ Heart Fail. 2019;12(1):e005512.PubMed

113.

Seemann F, Arvidsson P, Nordlund D, Kopic S, Carlsson M, Arheden H, et al. Noninvasive quantification of pressure-volume loops from brachial pressure and cardiovascular magnetic resonance. Circ Cardiovasc Imaging. 2019;12(1):e008493.PubMed

114.

Benza RL, Gomberg-Maitland M, Miller DP, Frost A, Frantz RP, Foreman AJ, et al. The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension. Chest. 2012;141(2):354–62.PubMed

115.

Hoeper MM, Kramer T, Pan Z, Eichstaedt CA, Spiesshoefer J, Benjamin N, et al. Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. Eur Respir J. 2017;50(2):1700740.

116.

Kylhammar D, Kjellstrom B, Hjalmarsson C, Jansson K, Nisell M, Soderberg S, et al. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension. Eur Heart J. 2018;39(47):4175–81.PubMed

117.

Boucly A, Weatherald J, Savale L, Jais X, Cottin V, Prevot G, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889.

118.

Thenappan T, Glassner C, Gomberg-Maitland M. Validation of the pulmonary hypertension connection equation for survival prediction in pulmonary arterial hypertension. Chest. 2012;141(3):642–50.PubMed

119.

Dellegrottaglie S, Ostenfeld E, Sanz J, Scatteia A, Perrone-Filardi P, Bossone E. Imaging the right heart-pulmonary circulation unit: the role of MRI and computed tomography. Heart Fail Clin. 2018;14(3):377–91.PubMed

120.

Ferrara F, Gargani L, Ostenfeld E, D'Alto M, Kasprzak J, Voilliot D, et al. Imaging the right heart pulmonary circulation unit: insights from advanced ultrasound techniques. Echocardiography. 2017;34(8):1216–31.PubMed

121.

Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T, et al. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation. 1983;68(2):302–9.PubMed

Title: Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?
Authors: Barbro Kjellström
Anthony Lindholm
Ellen Ostenfeld
Publication date: 01-10-2020
Publisher: Springer US
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Hypertension
Arterial Hypertension
Arterial Hypertension
Published in: Current Heart Failure Reports / Issue 5/2020
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI: https://doi.org/10.1007/s11897-020-00479-7

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