Possibilities of Magnetic Resonance Tomography in Diagnosis of Pulmonary Arterial Hypertension
https://doi.org/10.18087/cardio.2021.6.n1185
Abstract
The emergence of more effective methods for treatment of pulmonary arterial hypertension (PAH) has called for more reliable methods of diagnostics, monitoring, and evaluating responses to the treatment. More reports have become available about the relevance of using magnetic resonance imaging (MRI) for examination of patients with PAH. This review provides data on the significance of MRI for noninvasive evaluation of the heart structure and function in patients with PAH, as well as for visualization and evaluation of the remodeling of the pulmonary circulation. According to the data presented in this review, the results obtained with various, modern MRI technologies can be used for monitoring the effect of treatment and for risk stratification in patients with PAH.
Keywords
Magnetic resonance imaging,
pulmonary arterial hypertension,
myocardial strain,
pulmonary artery stiffness
Supporting agencies: No conflict of interest is reported.
About the Authors
A. M. Shariya
National Medical Research Center for Cardiology, Moscow
Russian Federation
Russian Federation
Laboratory assistant of Pulmonary Hypertension and Heart Disease Department
T. V. Martynyuk
National Medical Research Center for Cardiology, Moscow
Russian Federation
Russian Federation
MD, Head of Pulmonary Hypertension and Heart Disease Department
S. K. Ternovoy
National Medical Research Center for Cardiology, Moscow
Russian Federation
Russian Federation
Academician of Russian Academy of Science, MD, Professor, Head of the Department of Radiology
M. A. Shariya
National Medical Research Center for Cardiology, Moscow
Russian Federation
Russian Federation
Dr. Med. Sc., Professor, Leading Reseacher of the Department of Radiology
References
1. Chazova I.E., Martynyuk T.V., Valieva Z.S., Azizov V.A., Barbarash O.L., Veselova T.N. et al. Eurasian clinical guidelines on diagnosis and treatment of pulmonary hypertension. Eurasian Cardiology Journal. 2020;1(30):78–122. DOI: 10.24411/2076-4766-2020-10002
2. Chazova I.E., Yarovoy S.Yu., Danilov N.M. Evolution of pathogenetic therapy of pulmonary arterial hypertension. Therapeutic Archive. 2019;91(12):4–9. DOI: 10.26442/00403660.2019.12.000475
3. Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A et al. Diagnosis of pulmonary hypertension. European Respiratory Journal. 2019;53(1):1801904. DOI: 10.1183/13993003.01904-2018
4. Vonk Noordegraaf A, Galie N. The role of the right ventricle in pulmonary arterial hypertension. European Respiratory Review. 2011;20(122):243–53. DOI: 10.1183/09059180.00006511
5. Baggen VJM, Leiner T, Post MC, van Dijk AP, Roos-Hesselink JW, Boersma E et al. Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis. European Radiology. 2016;26(11):3771–80. DOI: 10.1007/s00330-016-4217-6
6. Peacock AJ, Crawley S, McLure L, Blyth KG, Vizza CD, Poscia R et al. Changes in Right Ventricular Function Measured by Cardiac Magnetic Resonance Imaging in Patients Receiving Pulmonary Arterial Hypertension–Targeted Therapy: The EURO-MR Study. Circulation: Cardiovascular Imaging. 2014;7(1):107–14. DOI: 10.1161/CIRCIMAGING.113.000629
7. Swift AJ, Capener D, Johns C, Hamilton N, Rothman A, Elliot C et al. Magnetic Resonance Imaging in the Prognostic Evaluation of Patients with Pulmonary Arterial Hypertension. American Journal of Respiratory and Critical Care Medicine. 2017;196(2):228–39. DOI: 10.1164/rccm.201611-2365OC
8. Lewis RA, Johns CS, Cogliano M, Capener D, Tubman E, Elliot CA et al. Identification of Cardiac Magnetic Resonance Imaging Thresholds for Risk Stratification in Pulmonary Arterial Hypertension. American Journal of Respiratory and Critical Care Medicine. 2020;201(4):458–68. DOI: 10.1164/rccm.201909-1771OC
9. Noordegraaf AV, Channick R, Cottreel E, Kiely D, Martin N, Moiseeva O et al. Results from the REPAIR Study Final Analysis: Effects ofMacitentan on Right Ventricular (RV) Remodelling in Pulmonary Arterial Hypertension (PAH). The Journal of Heart and Lung Transplantation. 2020;39(4):S16–7. DOI: 10.1016/j.healun.2020.01.1140
10. Swift A, Cogliano M, Oram C, Kendall L, Capener D, Garg P et al. Repeatability and Sensitivity to change of right ventricular analysis methods using cardiac magnetic resonance imaging in PAH: results from the RESPIRE Study. European Respiratory Journal. 2019;54(Suppl 63):PA3164 [DOI: 10.1183/13993003.congress-2019.PA3164] Av. at: http://erj.ersjournals.com/lookup/doi/10.1183/13993003.congress-2019.PA3164.
11. Swift AJ, Rajaram S, Condliffe R, Capener D, Hurdman J, Elliot CA et al. 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. Journal of Cardiovascular Magnetic Resonance. 2012;14(1):40. DOI: 10.1186/1532-429X-14-40
12. Hagger D, Condliffe R, Woodhouse N, Elliot CA, Armstrong IJ, Davies C et al. Ventricular mass index correlates with pulmonary artery pressure and predicts survival in suspected systemic sclerosis-associated pulmonary arterial hypertension. Rheumatology. 2009;48(9):1137–42. DOI: 10.1093/rheumatology/kep187
13. Belevskaya A.A., Dadacheva Z.Kh., Saidova M.A., Martynyuk T.V., Chazova I.E. The role of echocardiography in diagnosis of pulmonary hypertension and assessment of heart remodeling. Medical business. 2015;1:111–21.
14. Beyar R, Dong SJ, Smith ER, Belenkie I, Tyberg JV. Ventricular interaction and septal deformation: a model compared with experimental data. American Journal of Physiology-Heart and Circulatory Physiology. 1993;265(6):H2044–56. DOI: 10.1152/ajpheart.1993.265.6.H2044
15. Dellegrottaglie S, Sanz J, Poon M, Viles-Gonzalez JF, Sulica R, Goyenechea M et al. Pulmonary Hypertension: Accuracy of Detection with Left Ventricular Septal-to–Free Wall Curvature Ratio Measured at Cardiac MR. Radiology. 2007;243(1):63–9. DOI: 10.1148/radiol.2431060067
16. Swift A, Rajaram S, Condliffe R, Marshall H, Capener D, Hurdman J et al. Mean eccentricity index strongly reflects mPAP in patients with IPAH using CINE cardiac MRI. European Respiratory Journal. 2011;38(Suppl 55):1442. [Av. at: https://erj.ersjournals.com/content/38/Suppl_55/1442]
17. Yamasaki Y, Nagao M, Kamitani T, Yamanouchi T, Kawanami S, Yamamura K et al. Clinical impact of left ventricular eccentricity index using cardiac MRI in assessment of right ventricular hemodynamics and myocardial fibrosis in congenital heart disease. European Radiology. 2016;26(10):3617–25. DOI: 10.1007/s00330-015-4199-9
18. Ternovoy S.K. Heart tomography. -M.: GEOTAR-Media;2018. –296p. ISBN 978-5-9704-4608-9
19. Freed BH, Gomberg-Maitland M, Chandra S, Mor-Avi V, Rich S, Archer SL et al. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension. Journal of Cardiovascular Magnetic Resonance. 2012;14(1):11. DOI: 10.1186/1532-429X-14-11
20. Bessa LGP, Junqueira FP, Bandeira ML da S, Garcia MI, Xavier SS, Lavall G et al. Pulmonary Arterial Hypertension: Use of Delayed Contrast-Enhanced Cardiovascular Magnetic Resonance in Risk Assessment. Arquivos Brasileiros de Cardiologia. 2013;101(4):336–45. DOI: 10.5935/abc.20130168
21. Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P et al. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). Journal of Cardiovascular Magnetic Resonance. 2017;19(1):75. DOI: 10.1186/s12968-017-0389-8
22. Reiter U, Reiter G, Kovacs G, Adelsmayr G, Greiser A, Olschewski H et al. Native myocardial T1 mapping in pulmonary hypertension: correlations with cardiac function and hemodynamics. European Radiology. 2017;27(1):157–66. DOI: 10.1007/s00330-016-4360-0
23. Saunders LC, Johns CS, Stewart NJ, Oram CJE, Capener DA, Puntmann VO et al. Diagnostic and prognostic significance of cardiovascular magnetic resonance native myocardial T1 mapping in patients with pulmonary hypertension. Journal of Cardiovascular Magnetic Resonance. 2018;20(1):78. DOI: 10.1186/s12968-018-0501-8
24. de Siqueira MEM, Pozo E, Fernandes VR, Sengupta PP, Modesto K, Gupta SS et al. Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking. Journal of Cardiovascular Magnetic Resonance. 2016;18(1):39. DOI: 10.1186/s12968-016-0258-x
25. Padervinskienė L, Krivickienė A, Hoppenot D, Miliauskas S, Basevičius A, Nedzelskienė I et al. Prognostic Value of Left Ventricular Function and Mechanics in Pulmonary Hypertension: A Pilot Cardiovascular Magnetic Resonance Feature Tracking Study. Medicina. 2019;55(3):73. DOI: 10.3390/medicina55030073
26. Reiter U, Reiter G, Fuchsjäger M. MR phase-contrast imaging in pulmonary hypertension. The British Journal of Radiology. 2016;89(1063):20150995. DOI: 10.1259/bjr.20150995
27. Reiter G, Reiter U, Kovacs G, Olschewski H, Fuchsjäger M. Blood Flow Vortices along the Main Pulmonary Artery Measured with MR Imaging for Diagnosis of Pulmonary Hypertension. Radiology. 2015;275(1):71–9. DOI: 10.1148/radiol.14140849
28. Helderman F, Mauritz G-J, Andringa KE, Vonk-Noordegraaf A, Marcus JT. Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension. Journal of Magnetic Resonance Imaging. 2011;33(6):1362–8. DOI: 10.1002/jmri.22581
29. Nogami M, Ohno Y, Koyama H, Kono A, Takenaka D, Kataoka T et al. Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: Comparison with right heart catheterization and echocardiography. Journal of Magnetic Resonance Imaging. 2009;30(5):973–80. DOI: 10.1002/jmri.21935
30. Garcia-Alvarez A, Fernandez-Friera L, Mirelis JG, Sawit S, Nair A, Kallman J et al. Non-invasive estimation of pulmonary vascular resistance with cardiac magnetic resonance. European Heart Journal. 2011;32(19):2438–45. DOI: 10.1093/eurheartj/ehr173
31. Sanz J, Kariisa M, Dellegrottaglie S, Prat-González S, Garcia MJ, Fuster V et al. Evaluation of Pulmonary Artery Stiffness in Pulmonary Hypertension With Cardiac Magnetic Resonance. JACC: Cardiovascular Imaging. 2009;2(3):286–95. DOI: 10.1016/j.jcmg.2008.08.007
32. Tan W, Madhavan K, Hunter KS, Park D, Stenmark KR. Vascular Stiffening in Pulmonary Hypertension: Cause or Consequence? Pulmonary Circulation. 2014;4(4):560–80. DOI: 10.1086/677370
33. Ray JC, Burger C, Mergo P, Safford R, Blackshear J, Austin C et al. Pulmonary arterial stiffness assessed by cardiovascular magnetic resonance imaging is a predictor of mild pulmonary arterial hypertension. The International Journal of Cardiovascular Imaging. 2019;35(10):1881–92. DOI: 10.1007/s10554-018-1397-y
Review
For citations:
Shariya A.M., Martynyuk T.V., Ternovoy S.K., Shariya M.A. Possibilities of Magnetic Resonance Tomography in Diagnosis of Pulmonary Arterial Hypertension. Kardiologiia. 2021;61(6):97-104. (In Russ.) https://doi.org/10.18087/cardio.2021.6.n1185
Views:
1179
Email this article 
Post a Comment 
