Perioperative CTEPH patient monitoring with 2D phase-contrast MRI reflects clinical, cardiac and pulmonary perfusion changes after pulmonary endarterectomy.

Christoph P Czerner,Marius M Hoeper,Hinrich B Winther,Julius Renne,Christian Schoenfeld,Gesa H Pöhler,Serghei Cebotari,Karen M Olsson,Jens Vogel-Claussen,Till F Kaireit,Frank Wacker,Gabor Kovacs

doi:10.1371/journal.pone.0238171

Christoph P Czerner, Marius M Hoeper + Show 10 more

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https://doi.org/10.1371/journal.pone.0238171

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Abstract

Magnetic resonance imaging (MRI) is an emerging tool for diagnosis and treatment monitoring of chronic thromboembolic pulmonary hypertension (CTEPH). The current study aims to identify central pulmonary arterial hemodynamic parameters that reflect clinical, cardiac and pulmonary changes after PEA. 31 CTEPH patients, who underwent PEA and received pre- and postoperative MRI, were analyzed retrospectively. Central pulmonary arterial blood flow, lung perfusion and right heart function data were derived from MRI. Mean pulmonary arterial pressure (mPAP) and 5-month follow-up six-minute walk-distance (6MWD) were assessed. After PEA, mPAP decreased significantly and patients achieved a higher 6MWD. Central pulmonary arterial blood flow velocities, pulmonary blood flow (PBF) and right ventricular function increased significantly. Two-dimensional (2D) phase-contrast (PC) MRI-derived average mean velocity, maximum mean velocity and deceleration volume changes after PEA correlated with changes of 6MWD and right heart ejection fraction (RVEF). Deceleration volume is a novel 2D PC MRI parameter showing further correlation with PBF changes. In conclusion, 2D PC MRI-derived main pulmonary hemodynamic changes reflect changes of RVEF, PBF and 5-month follow-up 6MWD and may be used for future CTEPH patient monitoring after PEA.

Highlights

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, life-threatening disease
Following the latest diagnostic algorithm proposed in the”2015 guidelines for the diagnosis and treatment of pulmonary hypertension” of the European Respiratory Society, CTEPH should be diagnosed in specialized centers [2]
Between September 2011 und June 2016 we identified 83 CTEPH patients that underwent pulmonary endarterectomy (PEA) in our hospital, of which 72 received Magnetic resonance imaging (MRI) exams

Summary

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, life-threatening disease. Its primary treatment promising cure is pulmonary endarterectomy (PEA) [1,2,3,4,5]. Three-year survival after PEA is 89% compared to only 70% for non-surgical treatment [6]. PEA perioperative CTEPH patient monitoring with 2D PC MRI. Following the latest diagnostic algorithm proposed in the”2015 guidelines for the diagnosis and treatment of pulmonary hypertension” of the European Respiratory Society, CTEPH should be diagnosed in specialized centers [2]. Diagnosis includes findings from echocardiography, ventilation/perfusion lung scan, computed tomography pulmonary angiography, right heart catheterization and potentially pulmonary angiography [2]. Diagnostic approaches are to a certain degree center-specific. Echocardiography, clinical testing such as six-minute walk-distance (6MWD) and right-heart catheterization are usually employed for follow-up

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