Quantification of Cardiac Output with Phase Contrast Magnetic Resonance Imaging in Patients with Pulmonary Hypertension

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Abstract

Objective:

The purpose of the study is to compare phase contrast (PC) imaging with invasive measurements of cardiac output (CO) in patients with pulmonary hypertension (PH).

Materials and Methods:

We analyzed 81 cases with PH who underwent cardiac magnetic resonance imaging and right heart catheterization (RHC). Measurement of CO and stroke volume (SV) by cardiac magnetic resonance (CMR) was performed by PC imaging of the proximal aorta (Ao) and pulmonary artery (Pa) and by RHC using the Fick and thermodilution (TD) methods.

Results:

There was good correlation in CO measurements between PC and RHC; however, there was better correlation with SV measurements; Fick-TD (r=0.85), PC-TD (Ao r=0.77, Pa r=0.79), and PC-Fick (Ao r = 0.73, Pa r = 0.78). Bland-Altman analysis of SV showed that Pa PC had slightly lower standard deviation than Ao PC; PC-Fick (Pa SD = 15.11 vs. Ao SD = 16.4 ml) and PC-TD (Pa SD = 16.99 ml vs. Ao SD = 17.4 ml) while Fick-TD had the lowest (SD = 14.4 ml). Compared to Fick, measurement of SV with Ao PC (‒4.12 ml) and Pa PC (0.22 ml) both had lower mean difference than TD (‒11.1 ml).

Conclusion:

Non-invasive measurement of CO and SV using PC-CMR correlates well with invasive measurement using RHC. Our study showed that PC-CMR had high accuracy and precision when compared to Fick. Among all the modalities, PC-CMR contributed the least amount of variation in measurements.

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Most cited references 18

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Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.

Cynthia Binanay, Robert Califf, Vic Hasselblad … (2005)

Pulmonary artery catheters (PACs) have been used to guide therapy in multiple settings, but recent studies have raised concerns that PACs may lead to increased mortality in hospitalized patients. To determine whether PAC use is safe and improves clinical outcomes in patients hospitalized with severe symptomatic and recurrent heart failure. The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) was a randomized controlled trial of 433 patients at 26 sites conducted from January 18, 2000, to November 17, 2003. Patients were assigned to receive therapy guided by clinical assessment and a PAC or clinical assessment alone. The target in both groups was resolution of clinical congestion, with additional PAC targets of a pulmonary capillary wedge pressure of 15 mm Hg and a right atrial pressure of 8 mm Hg. Medications were not specified, but inotrope use was explicitly discouraged. The primary end point was days alive out of the hospital during the first 6 months, with secondary end points of exercise, quality of life, biochemical, and echocardiographic changes. Severity of illness was reflected by the following values: average left ventricular ejection fraction, 19%; systolic blood pressure, 106 mm Hg; sodium level, 137 mEq/L; urea nitrogen, 35 mg/dL (12.40 mmol/L); and creatinine, 1.5 mg/dL (132.6 micromol/L). Therapy in both groups led to substantial reduction in symptoms, jugular venous pressure, and edema. Use of the PAC did not significantly affect the primary end point of days alive and out of the hospital during the first 6 months (133 days vs 135 days; hazard ratio [HR], 1.00 [95% confidence interval {CI}, 0.82-1.21]; P = .99), mortality (43 patients [10%] vs 38 patients [9%]; odds ratio [OR], 1.26 [95% CI, 0.78-2.03]; P = .35), or the number of days hospitalized (8.7 vs 8.3; HR, 1.04 [95% CI, 0.86-1.27]; P = .67). In-hospital adverse events were more common among patients in the PAC group (47 [21.9%] vs 25 [11.5%]; P = .04). There were no deaths related to PAC use, and no difference for in-hospital plus 30-day mortality (10 [4.7%] vs 11 [5.0%]; OR, 0.97 [95% CI, 0.38-2.22]; P = .97). Exercise and quality of life end points improved in both groups with a trend toward greater improvement with the PAC, which reached significance for the time trade-off at all time points after randomization. Therapy to reduce volume overload during hospitalization for heart failure led to marked improvement in signs and symptoms of elevated filling pressures with or without the PAC. Addition of the PAC to careful clinical assessment increased anticipated adverse events, but did not affect overall mortality and hospitalization. Future trials should test noninvasive assessments with specific treatment strategies that could be used to better tailor therapy for both survival time and survival quality as valued by patients.

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Diagnosis and assessment of pulmonary arterial hypertension.

David B. Badesch, Hunter C Champion, Miguel Gómez Sánchez … (2009)

The diagnosis and assessment of pulmonary arterial hypertension is a rapidly evolving area, with changes occurring in the definition of the disease, screening and diagnostic techniques, and staging and follow-up assessment. The definition of pulmonary hypertension has been simplified, and is now based on currently available evidence. There has been substantial progress in advancing the imaging techniques and biomarkers used to screen patients for the disease and to follow up their response to therapy. The importance of accurate assessment of right ventricular function in following up the clinical course and response to therapy is more fully appreciated. As new therapies are developed for pulmonary arterial hypertension, screening, prompt diagnosis, and accurate assessment of disease severity become increasingly important. A clear definition of pulmonary hypertension and the development of a rational approach to diagnostic assessment and follow-up using both conventional and new tools will be essential to deriving maximal benefit from our expanding therapeutic armamentarium.

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Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers.

Christian Opitz, Xavier Jaïs, Daniel L Rubin … (2006)

This study sought to assess the risks associated with right heart catheter procedures in patients with pulmonary hypertension. Right heart catheterization, pulmonary vasoreactivity testing, and pulmonary angiography are established diagnostic tools in patients with pulmonary hypertension, but the risks associated with these procedures have not been systematically evaluated in a multicenter study. We performed a multicenter 5-year retrospective and 6-month prospective evaluation of serious adverse events related to right heart catheter procedures in patients with pulmonary hypertension, as defined by a mean pulmonary artery pressure >25 mm Hg at rest, undergoing right heart catheterization with or without pulmonary vasoreactivity testing or pulmonary angiography. During the retrospective period, 5,727 right heart catheter procedures were reported, and 1,491 were reported from the prospective period, for a total of 7,218 right heart catheter procedures performed. The results from the retrospective and the prospective analyses were almost identical. The overall number of serious adverse events was 76 (1.1%, 95% confidence interval 0.8% to 1.3%). The most frequent complications were related to venous access (e.g., hematoma, pneumothorax), followed by arrhythmias and hypotensive episodes related to vagal reactions or pulmonary vasoreactivity testing. The vast majority of these complications were mild to moderate in intensity and resolved either spontaneously or after appropriate intervention. Four fatal events were recorded in association with any of the catheter procedures, resulting in an overall procedure-related mortality of 0.055% (95% confidence interval 0.01% to 0.099%). When performed in experienced centers, right heart catheter procedures in patients with pulmonary hypertension are associated with low morbidity and mortality rates.

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Author and article information

Journal

Journal ID (nlm-ta): J Clin Imaging Sci

Journal ID (iso-abbrev): J Clin Imaging Sci

Journal ID (publisher-id): JCIS

Title: Journal of Clinical Imaging Science

Publisher: Scientific Scholar

ISSN (Print): 2156-7514

ISSN (Electronic): 2156-5597

Publication date (Electronic): 02 May 2020

Publication date Collection: 2020

Volume: 10

Electronic Location Identifier: 26

Affiliations

[1 ]Borgess Heart Institute , Ascension Borgess Hospital, 1722 Shaffer St., Kalamazoo, Michigan, United States

[2 ]Department of Cardiovascular Medicine , Wexner Medical Center, 410 W 10th Ave, Columbus, Ohio, United States

[3 ]Department of Cardiology , Fortis Hospital Mulund, Mumbai, Maharashtra, India.

[4 ]Department of Cardiology , Einstein Medical Center, 5401 Old York Road, Philadelphia, United States

[5 ]Cardiovascular Institute , Allegheny General Hospital, 320 E North Ave., Pittsburgh, Pennsylvania, United States,

Author notes

[* ] Corresponding author: Jose Ricardo Po,Borgess Heart Institute, Ascension Borgess Hospital, 1722 Shaffer St., Kalamazoo, MI, United States. josericardo.po@ 123456ascension.org

Article

Publisher ID: JCIS-10-26

DOI: 10.25259/JCIS_36_2020

PMC ID: 7193209

SO-VID: e8af1ac0-65eb-4282-955b-0be403518729

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Quantification of Cardiac Output with Phase Contrast Magnetic Resonance Imaging in Patients with Pulmonary Hypertension

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Abstract

Objective:

Materials and Methods:

Results:

Conclusion:

Related collections

Electron Channelling Contrast Imaging (ECCI)

Most cited references 18

Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.

Diagnosis and assessment of pulmonary arterial hypertension.

Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers.

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