Cardiovascular magnetic resonance imaging as applied to patients with pulmonary arterial hypertension

Abstract

Summary Numerous imaging techniques are currently used to evaluate pulmonary arterial hypertension (PAH), including echocardiography, x‐ray, electrocardiogram (ECG), computed tomography and magnetic resonance imaging (MRI). All such modalities have inherent advantages and disadvantages governed by physical principles that result in their clinical utility. In that PAH is a progressive disorder characterised by abnormally elevated blood pressure of the pulmonary circulation that leads to extensive vascular remodelling and increased pulmonary vascular resistance, a technique that can encapsulate those specific features that depict the multiple facets of this disease has obvious advantages. Recent advances in cardiovascular MRI (CMR) technology have led to the development of dedicated techniques for non‐invasive assessment of cardiovascular structure and function, including haemodynamical parameters in the pulmonary circulation, which are superior in their identification of pulmonary arterial right ventricular morphological changes. These advantages make CMR a very attractive modality for diagnosing, following and providing prognoses for PAH patients. In this review, we highlight the developments in the use of CMR for the diagnosis, assessment and monitoring of patients with PAH. These remarkable improvements in image acquisition, physiological imaging and contrast techniques place CMR in a prime position for defining this disease. In the coming decade, it is anticipated that continued improvements in CMR image acquisition, spatial and temporal resolution and analytical techniques will result in improved understanding of PAH pathophysiology, diagnosis and prognostic variables, as well as the replacement of the most, if not all, invasive procedures currently applied routinely to the evaluation of PAH.

Assessment of Pulmonary Artery Pulsatility by Multidetector Computed Tomography in Patients Affected by Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension: Preliminary Data

“…MDCT-derived pulsatility fairly agrees with that measured by IVU and MRI [11][12][13][14][15][16][17][18][19][20][21], indicating a mean pulsatility of 20% ± 5%. The pulsatility significantly diminishes in patients affected by PH, because of arterial remodelling leading to arterial stiffness [16,17].…”

“…The noninvasive cardiac echocardiography (US) allows the measurement of the pulmonary artery dimensions, the right ventriculare shape, the ejection fraction, and the noninvasive estimation of the systolic pulmonary artery pressure [15][16][17][18], but the applicability of US in patients affected by COPD is limited because of the reduced acoustic window [15], due to pulmonary hyperinflation. Within the imaging methods, magnetic resonance imaging (MRI) is extensively studied and allows the measurement of both morphologic and functional data such as Puls and pulmonary blood flow [19][20][21], but it is not widely available. Multidetector computer Tomography (MDCT) and cardiac software imaging are diffusely employed and available; they allow the detailed examination 2 ISRN Pulmonology of heart, coronary vessels, left ventricular function, and pulmonary arteries diameters [22][23][24][25][26][27][28].…”

Findings Associated with Pulmonary Hypertension: CT Angiography Based Study

“…Suspicion including symptoms and conditions which are associated with a risk for developing pulmonary hypertension. Early detection of pulmonary hypertension is vital for appropriate treatment [20]- [22]. Classification with a systematic approach to determine its cause to rule out the more common clinical groups of pulmonary hypertension such as left-sided heart disease, lung disease, and chronic thromboembolic pulmonary hypertension (CTEPH).…”

Pulmonary Hypertension Associated With Sarcoidosis

“…8,17 The utility of MRI to identify right heart abnormalities in the diagnosis of PH in sarcoidosis has not been studied, but may overcome some of the limitations of DE. 42 Brain natriuretic peptide (BNP) levels appear to have diagnostic utility for PH in lung disease, but require further validation. 43 A potentially important confounder with both cardiac imaging studies and BNP in the assessment of SAPH is cardiac involvement.…”