MRI Feature Tracking Strain in Pulmonary Hypertension: Utility of Combined Left Atrial Volumetric and Deformation Assessment in Distinguishing Post- From Pre-capillary Physiology

Frontiers in Cardiovascular Medicine

article

Kai'En Leong¹  Luke Howard³  Francesco Lo Giudice³  Holly Pavey⁶  Rachel Davies³  Gulammehdi Haji³  Simon Gibbs⁴  Deepa Gopalan¹ 

[1] Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital;Department of Cardiology, The Royal Melbourne Hospital;National Pulmonary Hypertension Service, Imperial College National Health Service Trust;National Heart and Lung Institute, Imperial College London;Department of Cardiology, Imperial College National Health Service Trust/Hammersmith Hospital;Division of Experimental Medicine and Immunotherapeutics, University of Cambridge;Department of Radiology, Cambridge University Hospitals National Health Service Trust

关键词: left atrial strain (LA strain);    pulmonary hypertension;    pre-capillary pulmonary hypertension;    post-capillary pulmonary hypertension;    feature tracking (CMR-FT);    cardiac MRI (CMR);   

DOI  :  10.3389/fcvm.2022.787656

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Aims Pulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous hemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE. Methods and Results Retrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 ± 14 vs. 42 ± 9 mmHg; p < 0.001) as was pulmonary vascular resistance (median 11.7 vs. 3.7 WU; p < 0.001). Post-capillary patients had significantly larger left atria (60 ± 22 vs. 25 ± 9 ml/m 2 ; p < 0.001). There was no difference in right atrial volumes between groups (60 ± 21 vs. 61 ± 29 ml/m 2 ; p = 0.694), however peak RA strain was lower in post-capillary PH patients (8.9 ± 5.5 vs. 18.8 ± 7.0%; p < 0.001). In the post-capillary group, there was commensurately severe peak strain impairment in both atria (LA strain 9.0 ± 5.8%, RA strain 8.9 ± 5.5%). CMR LAVi and peak LA strain had a multivariate AUC of 0.98 (95% CI 0.89–1.00; p < 0.001) for post-capillary PH diagnosis which was superior to TTE. Conclusion CMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.

【 授权许可】

CC BY