Pulmonary Hypertension

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. Several centers in Europe (Munich, London) and the USA (Bethesda, Washington) have considerable experience in pressure measurements in MRI. Their arguments for using 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 is alternative for cathlab diagnosis
  • Visibility of heart (right ventricle) and vessels is a major asset for both flow and pressure measurement

A live stream of an MRI guided RHC by Washington’s children’s hospital done as a live case at SCMR 2017. Meanwhile new centers in Paris and London have moved this procedure into into routine screening for PH (Knight et al, 2019).

 

Key papers

Knight et al (2019) Cardiovascular magnetic resonance-guided right heart catheterization in a conventional CMR environment – predictors of procedure success and duration in pulmonary artery hypertension. JCMR . https://doi.org/10.1186/s12968-019-0569-9

Ratnayka et al (2017) Radiation free CMR right heart catherization in children. Journal of Cardiovascular Magnetic Resonance . DOI 10.1186/s12968-017-0374-2

Rogers et al (2017) Journal of Cardiovascular Magnetic Resonance. CMR fluoroscopy right heart catherization for cardiac output  and pulmonary vascular resistance: results in 102 patients. DOI 10.1186/s12968-017-0366-2.

Pushparajah et al (2015) Cardiovascular magnetic resonance catheterization derived pulmonary vascular resistance and medium-term outcomes in congenital heart disease. J Cardiovasc Magn Reson. 14;17:28. doi: 10.1186/s12968-015-0130-4.

Muthurangu V et al (2004)Novel method of quantifying pulmonary vascular resistance by use of simultaneous invasive pressure monitoring and phase-contrast magnetic resonance flow. Circulation. 2004 Aug 17;110(7):826-34.

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