Source: Annual Congress 2011 - Physiology of human pulmonary hypertension
Disease area: Pulmonary vascular diseases

Abstract

Introduction
Several studies question the reliability of pulmonary capillary wedge pressure (PCWP) for accurate assessment of left ventricular end-diastolic pressure (LVEDP). Developing markers that can aid the separation of pre and post capillary pulmonary hypertension (PH) is desirable. Due to the elevated ventricular pressure differential in patients with PH the left ventricle becomes deformed. We hypothesise patients with PH owing to left heart disease (PH-LHD) have proportionately less left ventricular (LV) deformation than patients with IPAH due to raised left sided pressures.
Methods
92 patients underwent MRI and RHC within 48 hours; IPAH (n=34), PH-LHD (n=24) and ‘no PH‘ (n=34). Short axis CINE images were acquired on a 1.5T whole body MR scanner using a cardiac gated balanced SSFP sequence. LV deformation was defined in all patients using the measured left ventricular systolic eccentricity index (sEI^m). Linear regression was used to assess the relationship between sEI and mPAP in patients with PCWP ≤15, thus predicted sEI was derived (sEI^p) and was calculated for all patients.
Results
sEI^p values were significantly higher than sEI^m in patients with PH-LHD. No significant difference was demonstrated between sEI^p and sEI^m in patients with IPAH. Patients with PH-LHD demonstrated higher sEI^p/sEI^m values than those with IPAH, p<0.0001. A significant correlation was found between sEI^p/sEI^m and PCWP r=0.64, p<0.0001. Good interobserver agreement was demonstrated, k=0.80.
Conclusion
Patients with PH-LHD have proportionately less LV deformation than patients with pre-capillary PH. sEI^p/sEI^m may be a useful marker for differentiating pre from post capillary PH.

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Citations should be made in the following way:
A. Swift, S. Rajaram, R. Condliffe, H. Marshall, D. Capener, J. Hurdman, C. Elliot, J. Wild, D. Kiely (Sheffield, United Kingdom). Novel method for the estimation of PCWP using CINE cardiac MRI in patients with pulmonary hypertension. Eur Respir J 2011; 38: Suppl. 55, 2306

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