Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?
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IMAGING IN HEART FAILURE (J SCHULZ-MENGER, SECTION EDITOR)
Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines? Barbro Kjellström 1,2 & Anthony Lindholm 1 & Ellen Ostenfeld 1
# The Author(s) 2020
Abstract Purpose of Review Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH. Recent Findings New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling. Summary CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH. Keywords Pulmonary arterial hypertension . Ventricular remodelling . Atrial remodelling . Pulmonary artery . Tissue characterization . Outcome . Risk assessment
Introduction Pulmonary arterial hypertension (PAH) is a progressive disease with increased vascular resistance and arterial pressure in the pulmonary circulation. Symptoms such as dyspnoea and fatigue are vague, while there can be a long latency and delay to diagnosis [1]. Mortality is high and most commonly related directly or indirectly to right ventricular (RV) function [1]. While echocardiography currently is the first-line modality to assess cardiac function, assessment of RV volumes and
This article is part of the Topical Collection on Imaging in Heart Failure * Ellen Ostenfeld [email protected] Barbro Kjellström [email protected] Anthony Lindholm [email protected] 1
2
Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden Swedish Pulmonary Arterial Hypertension Registry, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
function is challenged by the one- and two-dimensional nature of echocardiography [2–5]. With the complexity of the RV structure, cardiovascular magnetic resonance imaging (CMR) plays an important role in the diagnosis and follow-up of patients with PAH [1, 6]. CMR is the gold standard for cardiac volumes, function, blood flow, and mass (Fig. 1), due to its high accuracy and reproducibility. Furthermore, CMR offers tissue characterization of the ventricular myocardium. In the 2015 ESC/ERS guidelines for diagnosis and treatment of pulmonary hypertension, the only imaging-related parameters included in the risk stratification are right atrial area and pericardial effusion with evidence f
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