| Objective: To evaluate the role of cardiac MRI(CMRI) in the diagnosis and treatment effect of pulmonary hypertension(PH), our study investigated the relationship of mean pulmonary arterial pressure(m PAP) measured by right heart catheterization(RHC) and parameters of right ventricle(RV) and main pulmonary artery(MPA) measured by CMRI in patients with PH, and acute ventricular response to inhalation of aerosolized iloprost in patients with pulmonary arterial hypertension(PAH) using CMRI.Methods : Fifty-two patients were enrolled from March 2012 to March 2014. ①Of the 52 cases, 39 patients with PH underwent CMRI(FIESTA and PC-MRI imaging)and RHC in one week. FIESTA images were post-processed and the following parameters of RV were obtained: end-diastolic volume(EDV), end-systolic volume(ESV), stroke volume(SV), ejection fraction(EF), cardiac output(CO), myocardial mass(MM), ventricular mass index(VMI), fractional tricuspid annulus apex distance change(fractional-TAAD), fractional distance change from septum to free-wall(fractional-SFD), diastolic RV/LV area ratio(d RV/LV area ratio), systolic RV/LV area ratio(s RV/LV area ratio), diastolic wall thickness(d WT), systolic wall thickness(s WT), curvature of interventricular septum(CIVS) and curvature ratio(RC).PC-MRI images were post-processed, and the following parameters of MPA were obtained: flow/beat, average velocity, maximum area(Amax), minimum area(Amin) and distensibility. Pearson correlation coefficient or Spearman rank correlation coefficient was employed for linear correlation analysis.②Of the 52 cases, 48 patients with PAH underwent CMRI before and immediately after inhalation of iloprost with a single dose of 20μg. Ventricular function parameters for both RV and LV derived from CMRI images were analyzed before and after iloprost inhalation,including EDV, ESV, SV, EF and CO. The end-diastolic area(EDA) and end-systolicarea(ESA) of RV were also obtained. Percentage of RV area change was calculated[%RVAC=(EDA-ESA)/EDA×100%]. Wilcoxon’s Sign Rank Test or Paired Samples t-Test was used to compare the differences of ventricular function parameters before and after inhalation.Results: ① dRV/LV area ratio, sRV/LV area ratio, dWT, sWT, RVEDV, RVESV,RVMM, VMI and Amax, Amin of MPA obtained by CMRI had positive correlation with m PAP measured by RHC(P<0.001, P=0.001, P<0.001, P=0.002, P=0.002,P<0.001, P<0.001, P<0.001, P=0.001, P=0.002, respectively); CIVS, Rc,fractional-TAAD, RVEF and flow/beat, average velocity, distensibility of MPA obtained by CMRI had negative correlation with m PAP measured by RHC(P<0.001,P<0.001, P=0.023, P=0.028, P=0.006, P<0.001, P=0.040, respectively); RVSV,RVCO and fractional-SFD obtained by CMRI had no significant correlation with m PAP measured by RHC(P=0.605, P=0.401, P=0.693, respectively).②After iloprost inhalation, all patients showed significant decrease in RVEDV, RVESV and LVESV(P=0.007, P<0.001, P=0.012, respectively). Whereas, there were significant increase in RVSV(P=0.014), RVEF(P=0.009), %RVAC(P=0.006), LVSV(P=0.032)and LVEF(P=0.001). RVCO(P=0.851), LVEDV(P=0.933) and LVCO(P=0.359) had no significant difference before and after inhalation.Conclusions: Many parameters of RV and MPA derived from CMRI had significant correlation with m PAP measured by RHC; ventricular function was immediately improved after inhalation of iloprost, which can be detected by CMRI. CMRI could accurately evaluate RV function and MPA hemodynamics changes in patients with PH and noninvasive evaluation of acute response of ventricular function after iloprost inhalation with CMRI is feasibility. CMRI is of great application value in the diagnosis and treatment effect of PH. |
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