January 1, 2012Open Access

Diagnostic accuracy of cardiovascular magnetic resonance imaging of right ventricular morphology and function in the assessment of suspected pulmonary hypertension results from the ASPIRE registry

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected pulmonary hypertension (n=233). Intervention: Cardiovascular Magnetic Resonance (CMR) imaging vs. Echocardiography. Primary outcome: Diagnostic accuracy (Area under the ROC curve) for the detection of pulmonary hypertension (mPAP ≥ 25 mmHg).

Key Result

Cardiovascular magnetic resonance-derived ventricular mass index accurately detected pulmonary hypertension with an area under the ROC curve of 0.91, compared to 0.88 for echocardiography.

Study Design

Type

Observational (n=233)

Blinding

Single-blind

Multicenter

PICO

Population

Suspected pulmonary hypertension (n=233)

Intervention / Comparator

Cardiovascular Magnetic Resonance (CMR) imaging vs Echocardiography

Primary Outcome

Diagnostic accuracy (Area under the ROC curve) for the detection of pulmonary hypertension (mPAP ≥ 25 mmHg)

Main Result

Absolute Event Rate: 0.91% vs 0.88%

Limitations

The MRI measurements were acquired retrospectively.
Echocardiography was performed several weeks prior to admission for RHC, limiting direct comparison.
The control group included patients with co-morbidities and cannot be considered healthy controls.
Several patients in the 'No PH' group had right ventricular dysfunction on CMR in the absence of significant pulmonary vascular disease.

Abstract

BACKGROUND: Cardiovascular Magnetic Resonance (CMR) imaging is accurate and reproducible for the assessment of right ventricular (RV) morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH) in the assessment of patients with suspected PH in the clinic setting is not well described. METHODS: We retrospectively studied 233 consecutive treatment naïve patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC) within 48 hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP ≥ 25 mmHg was assessed using Fisher's exact test and receiver operating characteristic (ROC) analysis. RESULTS: Ventricular mass index (VMI) was the CMR measurement with the strongest correlation with mPAP (r = 0.78) and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91) compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI ≥ 0.4, retrograde flow ≥ 0.3 L/min/m² and PA relative area change ≤ 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH. CONCLUSION: CMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension.

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