Key result
Time to systolic pressure reversal weakly correlates with pathological vortex flow duration, suggesting other causes.
Why the study?
Early systolic pressure reversal has been hypothesized to drive main pulmonary artery vortex formation in pulmonary hypertension, but has yet to be quantified in vivo.
Cross-Sectional (n=36)
Effect estimate: R2 0.17
p-value: p=0.012
Early systolic pressure reversal is weakly associated with vortical flow in the main pulmonary artery, suggesting it is not the sole driver of vortex formation in pulmonary hypertension.
Quantifying early systolic pressure reversal extends vortex-based mPAP estimation; leaves open whether 4D CMR can replace RHC for PH diagnosis.
Diagnosing pulmonary hypertension (PH) requires invasive right heart catheterization (RHC). However, mean pulmonary artery pressure (mPAP) can be non‐invasively estimated using 4D analysis of cardiovascular magnetic resonance (CMR) flow imaging to assess the duration of pathological vortex flow (T vortex ) in the main pulmonary artery (MPA). Early systolic pressure reversal has been hypothesized to drive vortex formation but has yet to be quantified in‐vivo. The virtual work‐energy relative pressure (vWERP) method enables accurate temporal characterization of intravascular pressure gradients from 4D analysis of CMR flow images. We aimed to characterize the relationship between T vortex and early systolic pressure reversal in the MPA using 4D analysis of CMR flow images from patients with a range of RHC‐determined mPAP. A total of 36 patients who underwent a clinically indicated RHC for any reason were recruited for a research‐motivated CMR‐exam. Intravascular MPA pressure gradients were estimated from a stack of multidirectional 2D‐flow slices covering the pulmonary artery using vWERP. Correlations between continuous variables were assessed using linear regression analysis. There were significant but weak correlations between time to systolic pressure reversal (T rev ) and T vortex ( R 2 : 0.17; p = 0.012), pulmonary vascular resistance (PVR) ( R 2 : 0.29; p = 0.001), and mPAP ( R 2 : 0.27; p = 0.001), respectively. Multivariable analysis showed no independent correlation between T vortex and T rev once either PVR or mPAP were added as predictor variables. Our results suggest that early systolic pressure reversal is associated with, but is unlikely to be the sole cause of, observed vortical flow in the MPA.
No takes yet. Share an insight, caveat, or question.
Karim et al. (2026) conducted a cross-sectional in Pulmonary hypertension (n=36). Time to systolic pressure reversal (T rev) was evaluated on Correlation between time to systolic pressure reversal (T rev) and duration of pathological vortex flow (T vortex) (R2 0.17, p=0.012). Time to systolic pressure reversal was weakly correlated with the duration of pathological vortex flow (R2 0.17; p=0.012), suggesting it is not the sole cause of vortical flow.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: