Cardiac magnetic resonance imaging in pulmonary arterial hypertension

Abstract

Cardiac magnetic resonance imaging (CMRI) provides accurate information about right ventricular (RV) mass, RV volumes and other markers of RV function. CMRI is proving to be a particularly useful tool in pulmonary arterial hypertension (PAH), as measures of RV function have been shown to be prognostic of long-term outcomes in this disease. Changes in RV function can also provide important information about a patient's disease course and response to treatment. As CMRI is noninvasive it can be used to regularly monitor patients with PAH, which is an important advantage over invasive right heart catheterisation. This review will explore the use of CMRI in the context of existing monitoring tools for PAH and will explore the forthcoming developments that are likely to be important in the future monitoring of patients with PAH.

Figure 1.

Cardiac magnetic resonance imaging in patients with pulmonary hypertension. a) Patient showing right ventricular hypertrophy with normal sized right and left ventricular volumes. b) Patient with end-stage right ventricular failure and a severely dilated right ventricle and atrium. Where the septum is bulging to the left, the right ventricular apex is blunted. RV: right ventricle; LV: left ventricle; RA: right atrium; IVS: interventricular septum.

Figure 2.

Kaplan–Meier survival curves for baseline cardiac magnetic resonance imaging variables according to the mean value in patients with pulmonary hypertension. a) Stroke volume index (SVI), b) right ventricle (RV) mass index, c) right ventricular end-diastolic volume index (RVEDVI), and d) left ventricular end-diastolic volume index (LVEDVI). Reproduced from [5] with permission from the publisher.

Figure 3.

Survival of patients with decreased pulmonary vascular resistance at month 12. RVEF: right ventricular ejection fraction. ^#: n=39; ^¶: n=13. Reproduced from [6] with permission from the publisher.

Figure 4.

Time to clinical worsening for patients with pulmonary hypertension and a) patients with and without the presence of right ventricular insertion point-late gadolinium enhancement (RVIP-LGE), b) patients with right ventricular ejection fraction (RVEF) ≥39% or <39%, c) patients with mean pulmonary arterial pressure (mPAP) ≥45 mmHg or <45 mmHg, and d) patients with metabolic equivalents (METs) ≥6.1 and <6.1. Reproduced from [45] with permission from the publisher.