Diagnostic accuracy of cardiovascular magnetic resonance imaging for assessment of right ventricular morphology and function in pulmonary artery hypertension

Assessment of RV function is complex and no single measurement is generally accepted in clinical practice, so PH is often diagnosed at a late stage of the disease, and is associated with poor survival. Cardiovascular magnetic resonance (CMRI) has become accepted as the gold standard technique for the assessment of the proximal pulmonary circulation and right ventricular function. It provides information about the right heart structure, volumes and function that is not readily obtained by other methods such as echocardiography and RHC. The aim of this study was to evaluate the diagnostic accuracy of a variety of CMR parameters as a non-invasive monitoring to study the right ventricular function and morphology in patients with PAH and if it has a role in early recognition and treatment important to improve long-term outcomes. This study included 40 patients with clinically suspected pulmonary hypertension. All were subjected to full clinical history and examination, laboratory investigations, echocardiography and CMRI. In the present study; there was highly significant positive correlation between RVEDV, RV mass index, RV mass and VMI with SPAP, mPAP and PVR, but highly significant statistical negative correlation between RVEF% and average velocity compared to SPAP, mPAP and PVR, RVSV. The most accurate CMRI indices for the detection of PH in the present study were VMI, RV mass index followed by RVEF and average velocity with their PPVs were 99%, 98%, 95% and 95% respectively. CMR imaging is likely to increase in importance as the optimal reference method for assessment of early structural (morphological) and functional parameters of the right ventricle for evaluation of patients with suspected PH valuable for assessment of treatment response, follow up and prognosis.