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. 2018 Apr;28(4):1438-1448.
doi: 10.1007/s00330-017-5143-y. Epub 2017 Nov 16.

Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging

C S Johns  1 , S Rajaram  2 , D A Capener  3 , C Oram  3 , C Elliot  2 , R Condliffe  2 , D G Kiely  2 , J M Wild  3 , A J Swift  3   4
Affiliations

Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging

C S Johns et al. Eur Radiol. 2018 Apr.

Abstract

Purpose: Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models.

Methods: Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size.

Results: Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030).

Conclusion: CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis.

Key points: • Pulmonary hypertension is a marker of poor outcome in COPD. • MRI can predict invasively measured mean pulmonary artery pressure. • Cardiac MRI allows for estimation of survival in COPD. • Cardiac MRI may be useful for follow up or future trials. • MRI is potentially useful to assess pulmonary hypertension in patients with COPD.

Keywords: Cardiac; Chronic Obstructive Pulmonary Disease; Cor Pulmonale; Magnetic Resonance Imaging; Pulmonary Hypertension.

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Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Dr Andrew Swift.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

This work was supported by NIHR grant NIHR-RP-R3-12-027, Wellcome grant 205188/Z/16/Z and MRC grant MR/M008894/1. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. D. Capener was part funded by an unrestricted research grant from Bayer.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Figures

Fig. 1
Fig. 1
Diagram showing the methodology of calculation of the cardiac MRI metrics. Pulmonary artery relative area change (a) taken from cine images taken at the level of the pulmonary trunk, perpendicular to the main pulmonary artery; septal angle (b) taken as the angle made between the insertion points of the RV to the mid septum on the end-systolic image from the short axis stack; and (c) ventricular mass index taken by segmentation of the muscle mass of the left and right ventricle on the stack of images taken in the short axis plane
Fig. 2
Fig. 2
Patient selection
Fig. 3
Fig. 3
Scatter plots showing correlations of each MRI model with right heart catheter measured mPAP
Fig. 4
Fig. 4
Bland-Altman plots showing accuracy of models against RHC-mPAP
Fig. 5
Fig. 5
ROC curve for the diagnosis of pulmonary hypertension
Fig. 6
Fig. 6
Kaplan-Meier survival tables, all dichotomised by 35
See this image and copyright information in PMC

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