Response to treatment assessment in patients with PAH by MRI based computational modelling

Abstract

Introduction: Pulmonary arterial hypertension (PAH) is a severe, low survival and rapidly progressive disease, characterised by an increase in the distal vascular resistance and decrease in the compliance. Right heart catheterisation (RHC) is the standard procedure for the PAH diagnosis and regular response to therapy assessment. Although the severe RHC associated risks are reduced, minimising the number of the interventions is highly desirable for improving patients9 life quality. Aim: The aim of the current study is to evaluate whether non-invasive measures of pulmonary vascular resistance and compliance can be used to assess the response to treatment in PAH patients. Methods: 93 patients diagnosed with PAH at RHC, underwent magnetic resonance imaging (MRI) of the main pulmonary artery at baseline and one year follow-up. At baseline, 56 patients were treatment naive and 37 on PAH therapy. A 3-element Windkessel model, using as input MRI flow and area waveforms, was implemented to compute the pulmonary resistance, R Wk and compliance, C Wk (Lungu et al., J Biomech 2014; 47:2941-7). R Wk and C Wk were compared at baseline with invasive pulmonary resistance, PVR, and vascular compliance, C SV computed as stroke volume to pulse pressure ratio. Results: At baseline, R Wk correlated with PVR (p Wk correlated with C SV (p Wk (p Wk (p Conclusion: The non-invasive proposed metrics have the potential to assess the response to PAH therapy, reducing the RHC interventions at follow-up.