Abstract
BackgroundIncreased pulmonary blood volume (PBV) is a measure of congestion and is associated with an increased risk of cardiovascular events. PBV can be quantified using cardiovascular magnetic resonance (CMR) imaging as the product of cardiac output and pulmonary transit time (PTT), the latter measured from the contrast time-intensity curves in the right and left side of the heart from first-pass perfusion (FPP). Several methods of estimating PTT exist, including pulmonary transit beats (PTB), peak-to-peak, and center of gravity (CoG). The aim of this study was to determine the accuracy and precision for these methods of quantifying the PBV, taking the left atrium volume (LAV) into consideration.MethodsFifty-eight participants (64 ± 11 years, 24 women) underwent 1.5 T CMR. PTT was quantified from (1) a basal left ventricular short-axis image (FPP), and (2) the reference method with a separate contrast administration using an image intersecting the pulmonary artery (PA) and the LA (CoG(PA-LA)).ResultsCompared to the reference, PBV for (a) PTB(FPP) was 14 ± 17% larger, (b) peak-peak(FPP) was 17 ± 16% larger, and (c) CoG(FPP) was 18 ± 10% larger. Subtraction of the LAV (available for n = 50) decreased overall differences to − 1 ± 19%, 2 ± 18%, and 3 ± 12% for PTB(FPP), peak-peak(FPP), and CoG(FPP), respectively. Lowest interobserver variability was seen for CoG(FPP) (− 2 ± 7%).ConclusionsCoG(PA-LA) and FPP methods measured the same PBV only when adjusting for the LAV, since FPP inherently quantifies a volume consisting of PBV + LAV. CoG(FPP) had the best precision and lowest interobserver variability among the FPP methods of measuring PBV.Graphical abstract
Highlights
Increased pulmonary blood volume (PBV) is a measure of congestion and is associated with an increased risk of cardiovascular events
This study is a head-to-head comparison of three different methods for quantifying the PBV using a first-pass perfusion (FPP) sequence, with the validated center of gravity (CoG)(PA-left atrial (LA)) as the reference method. It showed that (1) quantification of PBV using FPP images yields about 15–20% higher values compared to the reference method CoG(PA-LA), mainly explained by the inclusion of left atrium volume (LAV) in the FPP approach since images are acquired in the left ventricular (LV) instead of the LA, and (2) the CoG approach is the most robust method with regard to interobserver variability
The present study describes how measurements of PBV with FPP are achieved with the highest accuracy and precision using CoG(PA-LA) as reference
Summary
Increased pulmonary blood volume (PBV) is a measure of congestion and is associated with an increased risk of cardiovascular events. PBV can be quantified using cardiovascular magnetic resonance (CMR) imaging as the product of cardiac output and pulmonary transit time (PTT), the latter measured from the contrast timeintensity curves in the right and left side of the heart from first-pass perfusion (FPP). The aim of this study was to determine the accuracy and precision for these methods of quantifying the PBV, taking the left atrium volume (LAV) into consideration. The PROVE-HF study, where PBV was measured by CMR from a clinical firstpass perfusion (FPP) sequence, showed that heart failure outpatients who present with an elevated PBV indexed to body surface area (PBVI) had an increased risk of major adverse cardiac events [5]. The purpose of this study was to determine the accuracy and precision for different methods of quantifying PBV from FPP sequences using the CoG(PA-LA) method as reference standard, taking the LAV into consideration
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