A non-invasive assessment of cardiopulmonary hemodynamics with MRI in pulmonary hypertension.
OBJECTIVE
We propose a method for non-invasive quantification of hemodynamic changes in the pulmonary arteries resulting from pulmonary hypertension (PH).


METHODS
Using a two-element Windkessel model, and input parameters derived from standard MRI evaluation of flow, cardiac function and valvular motion, we derive: pulmonary artery compliance (C), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP), time-averaged intra-pulmonary pressure waveforms and pulmonary artery pressures (systolic (sPAP) and diastolic (dPAP)). MRI results were compared directly to reference standard values from right heart catheterization (RHC) obtained in a series of patients with suspected pulmonary hypertension (PH).


RESULTS
In 7 patients with suspected PH undergoing RHC, MRI and echocardiography, there was no statistically significant difference (p<0.05) between parameters measured by MRI and RHC. Using standard clinical cutoffs to define PH (mPAP>25mmHg), MRI was able to correctly identify all patients as having pulmonary hypertension, and to correctly distinguish between pulmonary arterial (mPAP>25mmHg, PCWP<15mmHg) and venous hypertension (mPAP>25mmHg, PCWP>15mmHg) in 5 of 7 cases.


CONCLUSIONS
We have developed a mathematical model capable of quantifying physiological parameters that reflect the severity of PH.
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY; Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Octavia
O
Bane
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Sanjiv J
SJ
Shah
Division of Pulmonary and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Michael J
MJ
Cuttica
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Jeremy D
JD
Collins
Feinberg School of Medicine, Northwestern University, Chicago, IL.
Senthil
S
Selvaraj
Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL.
Neil R
NR
Chatterjee
Siemens Corporation, Corporate Research, Princeton, NJ.
Christoph
C
Guetter
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
James C
JC
Carr
Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: t-carroll@northwestern.edu.
Timothy J
TJ
Carroll
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000502:physiology*
Compliance; Pulmonary hypertension; Pulmonary vascular resistance; Two-element Windkessel