Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging.
Eur Radiol
; 28(4): 1438-1448, 2018 Apr.
Article
en En
| MEDLINE
| ID: mdl-29147768
ABSTRACT
PURPOSE:
Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models.METHODS:
Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size.RESULTS:
Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030).CONCLUSION:
CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis. KEY POINTS ⢠Pulmonary hypertension is a marker of poor outcome in COPD. ⢠MRI can predict invasively measured mean pulmonary artery pressure. ⢠Cardiac MRI allows for estimation of survival in COPD. ⢠Cardiac MRI may be useful for follow up or future trials. ⢠MRI is potentially useful to assess pulmonary hypertension in patients with COPD.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Arteria Pulmonar
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Función Ventricular Derecha
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Imagen por Resonancia Cinemagnética
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Enfermedad Pulmonar Obstructiva Crónica
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Ventrículos Cardíacos
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Hipertensión Pulmonar
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur Radiol
Asunto de la revista:
RADIOLOGIA
Año:
2018
Tipo del documento:
Article
País de afiliación:
Reino Unido