Characterization of CMR-derived haemodynamic data in children with pulmonary arterial hypertension

Michal Schäfer*, D. Dunbar Ivy, Alex J. Barker, Vitaly Kheyfets, Robin Shandas, Steven H. Abman, Kendall S. Hunter, Uyen Truong

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Aims Paediatric pulmonary arterial hypertension (PAH) is manifested as increased arterial pressure and vascular resistive changes followed by progressive arterial stiffening. The aim of this study was to characterize regional flow haemodynamic patterns and markers of vascular stiffness in the proximal pulmonary arteries of paediatric PAH patients, and to explore the association with right ventricular (RV) function. Methods and results Forty paediatric PAH patients and 26 age- and size-matched controls underwent cardiac magnetic resonance studies in order to compute time-resolvedwall shear stress metrics, oscillatory shear index (OSI), and vascular strain as measured by relative area change (RAC), and RV volumetric and functional parameters. Phase-contrast imaging planes were positioned perpendicular to the mid-main and right pulmonary arteries (MPA and RPA, respectively). Compared with controls, the PAH group had decreased systolic wall shear stress (dyne cm22) and RAC (%) in both MPA (WSSsys: 6.5 vs. 4.3, P < 0.0001; RAC: 36 vs. 25, P < 0.0001) and RPA (WSSsys: 11.2 vs. 7.3, P < 0.0001; strain: 37 vs. 30, P < 0.05). The OSI was significantly higher in the MPA of PAH subjects (0.46 vs. 0.17, P < 0.05). WSS measured in the MPA correlated positively with RAC (r = 0.63, P < 0.0001) and RV ejection fraction (%) (r = 0.63, P < 0.0001). Conclusion Wall shear stress, the principal haemodynamic force driving endothelial functional changes, is severely decreased in paediatric PAH patients and correlates with increased stiffness in the proximal pulmonary vasculature and reduced RV function. All rights reserved.

Original languageEnglish (US)
Pages (from-to)424-431
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Volume18
Issue number4
DOIs
StatePublished - 2017

Keywords

  • Paediatric pulmonary arterial hypertension
  • Stiffness
  • Wall shear stress

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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