Abstract
Background: Pulmonary hypertension (PH) is a life-threatening. Differentiation pulmonary arterial hypertension (PAH) from pulmonary venous hypertension (PVH) is important due to distinct treatment protocols. Invasive right heart catheterization (RHC) remains the reference standard but noninvasive alternatives are needed. Purpose/Hypothesis: To evaluate 4D Flow MRI-derived 3D vortex energetics in the left pulmonary artery (LPA) for distinguishing PAH from PVH. Study Type: Prospective case–control. Population/Subjects: Fourteen PAH patients (11 female) and 18 PVH patients (9 female) diagnosed from RHC, 23 healthy controls (9 female). Field Strength/Sequence: 1.5 T; gradient recalled echo 4D flow and balanced steady-state free precession (bSSFP) cardiac cine sequences. Assessment: LPA 3D vortex cores were identified using the lambda2 method. Peak vortex-contained kinetic energy (vortex-KE) and viscous energy loss (vortex-EL) were computed from 4D flow MRI. Left and right ventricular (LV, RV) stroke volume (LVSV, RVSV) and ejection fraction (LVEF, RVEF) were computed from bSSFP. In PH patients, mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWR) and pulmonary vascular resistance (PVR) were determined from RHC. Statistical Tests: Mann–Whitney U test for group comparisons, Spearman's rho for correlations, logistic regression for identifying predictors of PAH vs. PVH and develop models, area under the receiver operating characteristic curve (AUC) for model performance. Significance was set at P < 0.05. Results: PAH patients showed significantly lower vortex-KE (37.14 [14.68–78.52] vs. 76.48 [51.07–120.51]) and vortex-EL (9.93 [5.69–25.70] vs. 24.22 [12.20–32.01]) than PVH patients. The combined vortex-KE and LVEF model achieved an AUC of 0.89 for differentiating PAH from PVH. Vortex-EL showed significant negative correlations with mPAP (rho = −0.43), PCWP (rho = 0.37), PVR (rho = −0.64). In the PAH group, PVR was significantly negatively correlated with LPA vortex-KE (rho = −0.73) and vortex-EL (rho = −0.71), and vortex-KE significantly correlated with RVEF (rho = 0.69), RVSV, (rho = 0.70). In the PVH group, vortex-KE (rho = 0.52), vortex-EL significantly correlated with RVSV (rho = 0.58). Data Conclusion: These preliminary findings suggest that 4D flow MRI-derived LPA vortex energetics have potential to noninvasively differentiate PAH from PVH and correlate with invasive hemodynamic parameters. Evidence Level: 1. Technical Efficacy: Stage 3.
| Original language | English (US) |
|---|---|
| Journal | Journal of Magnetic Resonance Imaging |
| DOIs | |
| State | Accepted/In press - 2024 |
Funding
J.C. was the PI of the Bayer grant that funded the original study that funded patient recruitment. J.C. has received institutional research grants from Siemens, Bayer and Guerbet, speaker honoraria from Bayer, Guerbet, Siemens and has served on advisory boards for Siemens, Bayer, Bracco and RoClub. M.M. and B.D.A. report a relationship with Third Coast Dynamics that includes board membership, employment, and equity or stocks. The authors gratefully acknowledge funding support from the National Institutes of Health (NIH) Award number R01HL169780, the data were collected as part of a study funded by Bayer Inc. This retrospective analysis study itself was not funded by Bayer. The funding body played no role in the study design, data collection, data analysis, or manuscript writing.
Keywords
- 4D Flow MRI
- pulmonary arterial hypertension
- pulmonary hypertension
- pulmonary venous hypertension
- vortex flow
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging