Quail, MA;
Knight, DS;
Steeden, JA;
Taelman, L;
Moledina, S;
Taylor, AM;
Segers, P;
... Muthurangu, V; + view all
(2015)
Non-Invasive Pulmonary Artery Wave Intensity Analysis in Pulmonary Hypertension.
Am J Physiol Heart Circ Physiol
, 308
(12)
H1603-H1611.
10.1152/ajpheart.00480.2014.
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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 non-invasively. We hypothesized that this method could detect differences in reflections between PH patients and controls and could also differentiate certain PH subtypes. 20 patients with PH (35% CTEPH, 75% female) and 10 healthy-controls (60% female) were recruited. Right and left pulmonary artery (LPA & RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5ms temporal resolution. This data was used to perform WIA on patients and controls. The presence of proximal clot in CTEPH patients was determined from contemporaneous CT/angiographic data. A backwards-travelling 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% CI 63-100%) and specificity of 91% (95% CI 75-98%) for the presence of clot in the proximal pulmonary arteries 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 non-invasive assessment of PH.
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