Qualification of Ventricular Flow in Patients With Precapillary Pulmonary Hypertension With 4-dimensional Flow Magnetic Resonance Imaging

Wenqing Xu; Mei Deng; Ling Zhang; Peiyao Zhang; Qian Gao; Xincao Tao; Yanan Zhen; Xiaopeng Liu; Ning Jin; Wenhui Chen; Wanmu Xie; Min Liu

doi:10.1097/RTI.0000000000000715

Qualification of Ventricular Flow in Patients With Precapillary Pulmonary Hypertension With 4-dimensional Flow Magnetic Resonance Imaging

J Thorac Imaging. 2023 May 15;38(6):374-382. doi: 10.1097/RTI.0000000000000715. Online ahead of print.

Authors

Wenqing Xu¹, Mei Deng², Ling Zhang³, Peiyao Zhang³, Qian Gao⁴, Xincao Tao⁴, Yanan Zhen⁵, Xiaopeng Liu⁵, Ning Jin⁶, Wenhui Chen⁴, Wanmu Xie⁴, Min Liu³

Affiliations

¹ Peking University China-Japan Friendship School of Clinical Medicine.
² Chinese Academy of Medical Sciences and Peking Union Medical College.
³ Department of Radiology.
⁴ Department of Pulmonary and Critical Care Medicine.
⁵ Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
⁶ Siemens Medical Solution, Chicago, IL, USA.

Abstract

Purpose: Our goal was to study both right and left ventricular blood flow in patients with precapillary pulmonary hypertension (pre-PH) with 4-dimensional (4D) flow magnetic resonance imaging (MRI) and to analyze their correlation with cardiac functional metrics on cardiovascular magnetic resonance (CMR) and hemodynamics from right heart catheterization (RHC).

Materials and methods: 129 patients (64 females, mean age 47 ± 13 y) including 105 patients with pre-PH (54 females, mean age 49 ± 13 y) and 24 patients without PH (10 females, mean age 40 ± 12 y) were retrospectively included. All patients underwent CMR and RHC within 48 hours. 4D flow MRI was acquired using a 3-dimensional retrospectively electrocardiograph-triggered, navigator-gated phase contrast sequence. Right and left ventricular flow components including the percentages of direct flow (PDF), retained inflow (PRI), delayed ejection flow (PDE), and residual volume (PRVo) were respectively quantified. The ventricular flow components between patients with pre-PH and non-PH were compared and correlations of flow components with CMR functional metrics and hemodynamics measured with RHC were analyzed. Biventricular flow components were compared between survivors and deceased patients during the perioperative period.

Results: Right ventricular (RV) PDF and PDE significantly correlated with RVEDV and RV ejection fraction. RV PDF negatively correlated with pulmonary arterial pressure (PAP) and pulmonary vascular resistance. When the RV PDF was <11%, the sensitivity and specificity of RV PDF for predicting mean PAP ≥25 mm Hg were 88.6% and 98.7%, respectively, with an area under the curve value of 0.95 ± 0.02. When RV PRVo was more than 42%, the sensitivity and specificity of RV PRVo for predicting mean PAP ≥25 mm Hg were 85.7% and 98.5%, respectively, with an area under the curve value of 0.95 ± 0.01. Nine patients died during the perioperative period. Biventricular PDF, RV PDE, and PRI of survivors were higher than nonsurvivors whereas RV PRVo increased in deceased patients.

Conclusions: Biventricular flow analysis with 4D flow MRI provides comprehensive information about the severity and cardiac remodeling of PH and may be a predictor of perioperative death of patients with pre-PH.