Diagnostic accuracy of cardiovascular magnetic resonance imaging of right ventricular morphology and function in the assessment of suspected pulmonary hypertension results from the ASPIRE registry

Abstract

BackgroundCardiovascular Magnetic Resonance (CMR) imaging is accurate and reproducible for the assessment of right ventricular (RV) morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH) in the assessment of patients with suspected PH in the clinic setting is not well described.MethodsWe retrospectively studied 233 consecutive treatment naïve patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC) within 48hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP ≥ 25 mmHg was assessed using Fisher’s exact test and receiver operating characteristic (ROC) analysis.ResultsVentricular mass index (VMI) was the CMR measurement with the strongest correlation with mPAP (r = 0.78) and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91) compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI ≥ 0.4, retrograde flow ≥ 0.3 L/min/m2 and PA relative area change ≤ 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH.ConclusionCMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension.

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…In patients with suspected PH, the presence of late gadolinium enhancement, reduced pulmonary arterial distensibility and retrograde flow have high predictive value for the identification of PH; however, no single CMR measurement can exclude PH [60][61][62]. In patients with PH, CMR may also be useful in cases of suspected CHD if echocardiography is not conclusive.…”

Prognostic Value of Cardiovascular Magnetic Resonance Imaging Measurements Corrected for Age and Sex in Idiopathic Pulmonary Arterial Hypertension

“…[3][4][5] The imaging modality has been proposed as a noninvasive tool in the clinical assessment of patients with pulmonary hypertension. [6][7][8] Van Wolferen et al 9 showed that when indexed for body surface area (BSA), a large RV volume, low stroke volume (SV), and a small left ventricular (LV) volume strongly predicted mortality in IPAH. However, cardiac volumes vary not only with BSA but also with age and sex, which are strong predictors of outcome.…”

Gerbode defect misinterpreted as pulmonary hypertension

“…In our case we confirmed that there was no significant residual intracardiac shunt. And perhaps more importantly, that this patient did not have significant pulmonary hypertension as was initially suspected; a right ventricular mass index of <20 g/m 2 by MRI is more reliable than echocardiography for excluding pulmonary hypertension [4]. Had there still been questions regarding the diagnosis, the superior image quality of transesophageal echocardiography can often delineate the location of the shunt.…”