Pulmonary hypertension (PH) is a condition that can have different causes, including pre-existing lung disease as well as congenital heart disease. PH may lead to cardiac effects such as right ventricle decompensation. The diagnosis of PH requires a right heart catherization (RHC) with measurement of pulmonary vascular pressure, cardiac output and calculation of the pulmonary vascular resistance (PVR).
Current procedures combine a CMR investigation (for flow and cardiac output) with a subsequent cathlab investigation to do invasive pressure measurement. Several clinical centers now advocate to do all hemodynamic measurements in the MRI as a one-stop-shop approach. Both German Heart Centre Munich and NIH in Bethesda have considerable experience in doing this. Their arguments for CMR:
- Pulmonary vascular resistance can be calculated from invasive pressure measurement and MRI-flow derived cardiac output. Fick’s principle is not needed.
- One-stop shop hemodynamics makes cathlab diagnosis redundant
- Visibility of heart (right ventricle) and vessels is a major asset for both flow and pressure measurement