Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure
| Autor: | Alexander Fyrdahl, Kenneth Caidahl, Martin Ugander, Ursula Reiter, Peder Sörensson, Gert Reiter, Björn Wieslander, Andreas Sigfridsson, Maria J. Eriksson, Eva Maret, Ning Jin, Joao G. Ramos |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty lcsh:Medical technology Hypertension Pulmonary 4D flow Magnetic Resonance Imaging Cine 030204 cardiovascular system & hematology Doppler echocardiography Sensitivity and Specificity 030218 nuclear medicine & medical imaging Pulmonary hypertension 03 medical and health sciences 0302 clinical medicine Imaging Three-Dimensional Magnetic resonance imaging Interquartile range Internal medicine medicine.artery medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Pressure gradient Aged Cardiac cycle medicine.diagnostic_test business.industry Blood flow Middle Aged medicine.disease Echocardiography Doppler lcsh:R855-855.5 Echocardiography Pulmonary artery Cardiology Female business Research Article |
| Zdroj: | BMC Medical Imaging, Vol 20, Iss 1, Pp 1-9 (2020) BMC Medical Imaging |
| ISSN: | 1471-2342 |
| DOI: | 10.1186/s12880-020-00428-9 |
| Popis: | Background Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Methods Consecutive clinically referred patients (n = 60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5 T (n = 43) or 3 T (n = 17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity > 2.8 m/s (TRPG > 31 mmHg). Results Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27–0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p 2 = 0.65, p Conclusions There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings. |
| Databáze: | OpenAIRE |
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