Abstract
(1) Background: Pulmonary arterial hypertension (PAH) is a serious condition that is associated with many cardiopulmonary diseases. Invasive right heart catheterization (RHC) is currently the only method for the definitive diagnosis and follow-up of PAH. In this study, we sought a non-invasive hemodynamic biomarker for the diagnosis of PAH. (2) Methods: We applied prospectively respiratory and cardiac gated 4D-flow MRI at a 9.4T preclinical scanner on three different groups of Sprague Dawley rats: baseline (n = 11), moderate PAH (n = 8), and severe PAH (n = 8). The pressure gradients as well as the velocity values were analyzed from 4D-flow data and correlated with lung histology. (3) Results: The pressure gradient between the pulmonary artery and vein on the unilateral side as well as the time-averaged mean velocity values of the small pulmonary arteries were capable of distinguishing not only between baseline and severe PAH, but also between the moderate and severe stages of the disease. (4) Conclusions: The current preclinical study suggests the pulmonary arteriovenous pressure gradient and the time-averaged mean velocity as potential biomarkers to diagnose PAH.
Highlights
Pulmonary hypertension (PH) is a life-threatening condition that is defined as an increase in mean pulmonary artery pressure above 20 mmHg when measured by right heart catheterization (RHC) at rest [1,2]
Pulmonary arterial hypertension (PAH) is categorized as the first group in the PH classification, which is described in detail in the clinical guidelines of the European Society of Cardiology [1]
There are a variety of pitfalls when assessing and interpreting the parameters determined by RHC; for example, the measurement of the pulmonary artery wedge pressure at an over- or under-wedge position can lead to incorrect results [8]
Summary
Pulmonary hypertension (PH) is a life-threatening condition that is defined as an increase in mean pulmonary artery pressure above 20 mmHg when measured by right heart catheterization (RHC) at rest [1,2]. As an invasive diagnostic tool, RHC can cause intra- or postprocedure complications, such as hematomas, pulmonary artery ruptures, or damage to the electrical conduction system of the heart [9]. It is contraindicated under certain circumstances such as in mechanical tricuspid or pulmonary valve replacement, right heart masses, etc. The most promising non-invasive hemodynamic index was the time-averaged mean velocity of the main pulmonary artery [19] For this purpose, we evaluated this index in the small pulmonary arteries in 4D-flow and its correlation with histology to assess its suitability for diagnosing PAH. A comprehensive correlation analysis of all the CMR findings in relation to the histology results was performed
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