Current and emerging imaging techniques in the diagnosis and assessment of pulmonary hypertension

Johns, Chris; Wild, Jim M.; Rajaram, Smitha; Swift, Andy; Kiely, David G.

doi:10.1080/17476348.2018.1420478

Cited by 9 publications

(10 citation statements)

References 128 publications

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“…In a breathless patient, PH is increasingly suggested on common investigations such as chest radiography, echocardiogram or computer tomography [ 1 , 12 ]. New advances in noninvasive imaging techniques have helped to establish the diagnosis of PH sooner in the course of the disease [ 13 , 14 ]. Cardiac MRI has been used to estimate mPAP to provide diagnosis through non-invasive means.…”

Section: Diagnosismentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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Purpose of Review This article reviews advances over the past 3 years in cardiac magnetic resonance (CMR) imaging in pulmonary hypertension (PH). We aim to bring the reader up-to-date with CMR applications in diagnosis, prognosis, 4D flow, strain analysis, T1 mapping, machine learning and ongoing research. Recent Findings CMR volumetric and functional metrics are now established as valuable prognostic markers in PH. This imaging modality is increasingly used to assess treatment response and improves risk stratification when incorporated into PH risk scores. Emerging techniques such as myocardial T1 mapping may play a role in the follow-up of selected patients. Myocardial strain may be used as an early marker for right and left ventricular dysfunction and a predictor for mortality. Machine learning has offered a glimpse into future possibilities. Ongoing research of new PH therapies is increasingly using CMR as a clinical endpoint. Summary The last 3 years have seen several large studies establishing CMR as a valuable diagnostic and prognostic tool in patients with PH, with CMR increasingly considered as an endpoint in clinical trials of PH therapies. Machine learning approaches to improve automation and accuracy of CMR metrics and identify imaging features of PH is an area of active research interest with promising clinical utility.

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Section: Diagnosismentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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“…Figure 1 shows the IVS angle in one patient with high DPG and another with normal DPG. The standard cardiac contours and metrics were measured and calculated (16,20), as previously published. A description of these is available in Appendix E1 (online).…”

Section: Methodsmentioning

confidence: 99%

Identifying At-Risk Patients with Combined Pre- and Postcapillary Pulmonary Hypertension Using Interventricular Septal Angle at Cardiac MRI

Johns¹,

Wild²,

Rajaram³

et al. 2018

Radiology

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Purpose To assess interventricular septal (IVS) angle in the identification of combined pre- and postcapillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension (PH) due to left-sided heart disease. Materials and Methods In this retrospective study, consecutive, incident patients suspected of having PH underwent same-day right-sided heart catheterization (RHC) and MRI at a PH referral center between April 2012 and April 2017. The diagnostic accuracy of the IVS angle to identify Cpc-PH in patients with pulmonary arterial wedge pressure (PAWP) greater than 15 mmHg was assessed by using receiver operator characteristic curves, sensitivity, specificity, and negative and positive predictive values. IVS angle also was assessed as a predictor of all-cause mortality by using Cox uni- and multivariable proportional hazards regression. Results A total of 708 patients underwent same-day MRI and RHC, and 171 patients had PAWP greater than 15 mmHg. Mean age was 70 years (range, 21–90 years) (women: mean age, 69 years; range, 21–88 years) (men: mean age, 71 years; range, 43–90 years). Systolic IVS angle correlated with diastolic pulmonary gradient (DPG) ( r = 0.739, P < .001). Receiver operating characteristic curve analysis showed septal angle enabled identification of Cpc-PH (DPG ≥ 7), with an area under the receiver operating characteristic curve of 0.911 ( P < .001). A 160° threshold, derived from the first half of patients with raised PAWP, enabled identification of a DPG of at least 7 mmHg with 67% sensitivity and 93% specificity ( P < .001) in the second cohort of patients with raised PAWP. IVS angle was predictive of all-cause mortality (standardized univariable hazard ratio, 1.615; P < .01). Conclusion The systolic interventricular septal angle is elevated in patients with combined pre- and postcapillary pulmonary hypertension and enables one to predict those patients who have PH due to left-sided heart disease who have an increased risk of death. Published under a CC BY 4.0 license. Online supplemental material is available for this article.

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“…This may be achieved by systematic screening of at-risk populations 14 , 18 . There are a number of tools including, clinical assessment, blood biomarkers, imaging, and exercise testing that can be utilized in screening programmes to improve the detection of PAH 1 , 19–23 …”

Section: Introductionmentioning

confidence: 99%

Screening strategies for pulmonary arterial hypertension

Kiely

Lawrie

Humbert

2019

European Heart Journal Supplements

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Pulmonary arterial hypertension (PAH) is rare and, if untreated, has a median survival of 2–3 years. Pulmonary arterial hypertension may be idiopathic (IPAH) but is frequently associated with other conditions. Despite increased awareness, therapeutic advances, and improved outcomes, the time from symptom onset to diagnosis remains unchanged. The commonest symptoms of PAH (breathlessness and fatigue) are non-specific and clinical signs are usually subtle, frequently preventing early diagnosis where therapies may be more effective. The failure to improve the time to diagnosis largely reflects an inability to identify patients at increased risk of PAH using current approaches. To date, strategies to improve the time to diagnosis have focused on screening patients with a high prevalence [systemic sclerosis (10%), patients with portal hypertension assessed for liver transplantation (2–6%), carriers of mutations of the gene encoding bone morphogenetic protein receptor type II, and first-degree relatives of patients with heritable PAH]. In systemic sclerosis, screening algorithms have demonstrated that patients can be identified earlier, however, current approaches are resource intensive. Until, recently, it has not been considered possible to screen populations for rare conditions such as IPAH (prevalence 5–15/million/year). However, there is interest in the use of artificial intelligence approaches in medicine and the application of diagnostic algorithms to large healthcare data sets, to identify patients at risk of rare conditions. In this article, we review current approaches and challenges in screening for PAH and explore novel population-based approaches to improve detection.

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Current and emerging imaging techniques in the diagnosis and assessment of pulmonary hypertension

Cited by 9 publications

References 128 publications

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Identifying At-Risk Patients with Combined Pre- and Postcapillary Pulmonary Hypertension Using Interventricular Septal Angle at Cardiac MRI

Screening strategies for pulmonary arterial hypertension

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