title: Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension.
abstract: Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e(-8)). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63-100%] and specificity of 91% (95% CI 75-98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.
authors: Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
authors: Michael A
authors: MA
authors: Quail
authors: Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom; Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and.
authors: Daniel S
authors: DS
authors: Knight
authors: Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
authors: Jennifer A
authors: JA
authors: Steeden
authors: IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium.
authors: Liesbeth
authors: L
authors: Taelman
authors: Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
authors: Shahin
authors: S
authors: Moledina
authors: Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
authors: Andrew M
authors: AM
authors: Taylor
authors: IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium.
authors: Patrick
authors: P
authors: Segers
authors: Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and.
authors: Gerry J
authors: GJ
authors: Coghlan
authors: Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom; v.muthurangu@ucl.ac.uk.
authors: Vivek
authors: V
authors: Muthurangu
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D063177:Pulse Wave Analysis; D013997:Time Factors
keywords: cardiac magnetic resonance imaging; hemodynamics; pulmonary hypertension; wave intensity