Diagnostic accuracy of cardiovascular magnetic resonance of right ventricular morphology and function in the assessment of suspected pulmonary hypertension
Andrew J Swift, Smitha Rajaram, Robin Condliffe, Dave Capener, Judith Hurdman, Charlie A Elliot, Jim M Wild and David G Kiely
Background Cardiovascular Magnetic Resonance (CMR) is accurate and reproducible for the assessment of right ventricular (RV) morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH) in the assessment of patients with suspected PH in the clinic setting is not well described. Methods We retrospectively studied 233 consecutive treatment naive patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC) within 48hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP [greater than or equal to] 25 mmHg was assessed using Fisher's exact test and receiver operating characteristic (ROC) analysis. Results Ventricular mass index (VMI) was the CMR measurement with the strongest correlation with mPAP (r = 0.78) and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91) compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI [greater than or equal to] 0.4, retrograde flow [greater than or equal to] 0.3 L/min/m2 and PA relative area change [less than or equal to] 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH. Conclusion CMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension. Journal of Cardiovascular Magnetic Resonance 2012, 14:40
Andrew J Swift, Smitha Rajaram, Robin Condliffe, Dave Capener, Judith Hurdman, Charlie A Elliot, Jim M Wild and David G Kiely
Background Cardiovascular Magnetic Resonance (CMR) is accurate and reproducible for the assessment of right ventricular (RV) morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH) in the assessment of patients with suspected PH in the clinic setting is not well described. Methods We retrospectively studied 233 consecutive treatment naive patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC) within 48hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP [greater than or equal to] 25 mmHg was assessed using Fisher's exact test and receiver operating characteristic (ROC) analysis. Results Ventricular mass index (VMI) was the CMR measurement with the strongest correlation with mPAP (r = 0.78) and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91) compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI [greater than or equal to] 0.4, retrograde flow [greater than or equal to] 0.3 L/min/m2 and PA relative area change [less than or equal to] 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH. Conclusion CMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension. Journal of Cardiovascular Magnetic Resonance 2012, 14:40
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