Key result
Cardiac magnetic resonance-based 4D-flow analysis demonstrated fair diagnostic performance for identifying combined postcapillary pulmonary hypertension (AUC 0.768; 95% CI 0.572-0.963).
Why the study?
Noninvasive techniques for diagnosing combined postcapillary pulmonary hypertension were unavailable.
Does CMR-based 4D-flow analysis identify combined postcapillary pulmonary hypertension in heart failure patients with suspected pulmonary hypertension?
Observational (n=46)
Does CMR-based 4D-flow analysis identify combined postcapillary pulmonary hypertension in heart failure patients with suspected pulmonary hypertension?
CMR-based 4D-flow analysis provides a noninvasive multiparametric model with fair diagnostic performance for identifying combined postcapillary pulmonary hypertension in heart failure patients.
Background: Noninvasive techniques for diagnosing combined postcapillary pulmonary hypertension (CpcPH) are unavailable. Objective: To assess the diagnostic performance of cardiac magnetic resonance (CMR)-based four-dimensional (4D)-flow analysis in identifying CpcPH. Methods: Prospective observational study of heart failure (HF) patients with suspected pulmonary hypertension (PH) who underwent simultaneous CMR and right heart catheterization. The 4D-flow biomarkers were calculated using an automatic pipeline. A predictive model including 4D-flow biomarkers associated with CpcPH with a p-value < 0.20 was built to determine the diagnostic performance of 4D-flow analysis to identify CpcPH. Results: A total of 46 HF patients (55.4 ± 14 years, 63% male) with confirmed PH (19 [41%] isolated postcapillary PH [IpcPH], 27 [59%] CpcPH) were included. No differences were found in baseline characteristics, echocardiography, or CMR anatomical and functional parameters, except for a higher Doppler-estimated systolic pulmonary pressure and larger pulmonary artery in CpcPH patients. The 4D-flow CMR analysis was performed in 31 patients (67%). The maximal peak velocity (67.1 [62.2–77.5] cm/s—IpcPH vs. 58.2 [45.8–66.0] cm/s—CpcPH; p = 0.021) and maximal helicity (339.9 [290.0–391.8]) cm/s2—IpcPH vs. 226.0 (173.5–343.7) cm/s2—CpcPH; p = 0.026) were significantly lower in patients with CpcPH. A maximal multivariable model including sex, maximal average, and peak velocities, Reynolds number, flow rate, and helicity showed fair diagnostic performance (area under the curve: 0.768 [95%-CI: 0.572–0.963]; sensitivity: 100%; specificity: 55%). Conclusions: In HF patients with PH, 4D-flow-derived maximal peak velocity and maximal helicity were significantly lower in CpcPH patients. A multiparametric model including maximal 4D-flow-derived biomarkers showed good diagnostic performance for identifying CpcPH.
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Nuche et al. (2025) conducted an observational in Heart failure with pulmonary hypertension (n=46). Cardiac magnetic resonance-based 4D-flow analysis vs. Isolated postcapillary pulmonary hypertension (IpcPH) was evaluated on Diagnostic performance of a multiparametric 4D-flow CMR model to identify combined postcapillary pulmonary hypertension (CpcPH) (AUC 0.768, 95% CI 0.572-0.963). Cardiac magnetic resonance-based 4D-flow analysis demonstrated fair diagnostic performance for identifying combined postcapillary pulmonary hypertension (AUC 0.768; 95% CI 0.572-0.963).
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