Andrew James Swift BMedSc, FRCR, Presenter: Nothing to Disclose

Smitha Rajaram MBBS, Abstract Co-Author: Nothing to Disclose

Robin Condliffe MD, Abstract Co-Author: Nothing to Disclose

David Capener, Abstract Co-Author: Nothing to Disclose

Catherine Hill MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

Christine Helen Davies, Abstract Co-Author: Nothing to Disclose

Judith Hurdman MD, Abstract Co-Author: Nothing to Disclose

Charlie Elliot MBBS, Abstract Co-Author: Nothing to Disclose

Jim M. Wild PhD, Abstract Co-Author: Nothing to Disclose

David Kiely MD, Abstract Co-Author: Advisory Board, Eli Lilly and Company Advisory Board, Actelion Ltd Advisory Board, Bayer AG Advisory Board, glaxoSmithKline plc Research funded, Actelion Ltd Research funded, Pfizer Inc Research funded, Bayer AG

Decreased compliance of the pulmonary vasculature bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). Pulmonary artery relative area change (RAC), has been shown to predict mortality in patients with PAH, but its prognostic value across the varied aetiologies of pulmonary hypertension (PH) has not been assessed. This study examines the diagnostic and prognostic value of RAC of the main pulmonary artery in an unselected cohort of patients with pulmonary hypertension using CINE MRI.

168 patients with suspected PH underwent right heart catheterisation and MR Imaging on a 1.5T scanner within 48 hours. CINE imaging was performed orthogonal to the main pulmonary artery trunk using a 2D balanced steady state free precession sequence. RAC of the pulmonary artery was calculated from the following formula [(maximum area-minimum area)/maximum area]100. Kaplan Meier plots and Cox proportional hazard regression were used to assess the prognostic value of RAC, oxygen uptake (VO2), right atrial pressure (RAP), cardiac index (CI), PVR and patient age.

Our PH patient group included 62 patients with PAH, 23 patients with PH owing to left heart disease, 15 patients with PH due to lung diseases and/or hypoxia and 45 patients with chronic thromboembolic pulmonary hypertension. 23 patients without PH served as controls. RAC ≤ 13% identified from ROC curve analysis demonstrated high sensitivity (84%) and specificity (72%) for the diagnosis of PH (area under the curve, 82%). Mean RAC was significantly lower for patients with PH (8% ± 7%) than those without PH (17% ± 8%). During our mean follow-up of 15 months, 19 patients died. Analysis of Kaplan Meier plots using the median RAC value of 7.04% predicted mortality (log rank test, p=0.029). RAC was a significant predictor of mortality on univariate Cox regression analysis, hazard ratio 0.85 (CI 0.75-0.96; p=0.009), multivariate analysis identified RAC and CI as independent predictors of survival, hazard ratios 0.85 (CI 0.74-0.97; p=0.017) and 2.10 (CI 1.06-4.13; p=0.034) respectively.  

RAC calculated from CINE MRI is an independent predictor of mortality in unselected patients with suspected PH

Non-invasive assessment of RAC using MRI strongly predicts mortality in patients with suspected pulmonary hypertension independent of invasive haemodynamic indices

Swift, A, Rajaram, S, Condliffe, R, Capener, D, Hill, C, Davies, C, Hurdman, J, Elliot, C, Wild, J, Kiely, D, Pulmonary Artery Relative Area Change Using CINE MRI Independently Predicts Mortality in Patients with Suspected Pulmonary Hypertension.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011177.html