What is the clinical evidence from this study?

Study design: Observational. Population: Pulmonary Arterial Hypertension (n=19). Intervention: 4D Flow MRI vs. Healthy subjects. Primary outcome: Right ventricular kinetic energy work density (p=0.007).

September 29, 2015PLoS ONE55 citationsOpen Access

Altered Right Ventricular Kinetic Energy Work Density and Viscous Energy Dissipation in Patients with Pulmonary Arterial Hypertension: A Pilot Study Using 4D Flow MRI

QHQiao Han WWWalter R. Witschey CFChristopher Fang‐Yen

Key Result

Patients with pulmonary arterial hypertension had significantly higher right ventricular kinetic energy work density (94.7 vs 61.7 mJ/mL) and percent pulmonary artery energy loss compared to healthy subjects.

Key Points

To evaluate right ventricular kinetic energy work density and viscous energy dissipation in patients with pulmonary arterial hypertension using 4D Flow MRI.
Conducted a pilot single-center imaging study evaluating a small clinical cohort at the University of Pennsylvania.
Utilized 4D Flow MRI techniques to capture cardiac fluid dynamics and energy metrics in the right ventricle.
Demonstrates altered patterns of right ventricular kinetic energy work density in patients with pulmonary arterial hypertension.
Identifies changes in viscous energy dissipation, reflecting impaired right ventricular hemodynamic efficiency and increased workload.

Study Design

Type

Observational (n=19)

Multicenter

Structured PICO

Does 4D flow MRI identify altered right ventricular kinetic energy work density and viscous energy dissipation in patients with pulmonary arterial hypertension compared to healthy subjects?

Population

19 subjects total: 10 patients with pulmonary arterial hypertension (PAH) (mean PA pressure ≥ 25 mmHg, 9 WHO Group 1, 1 WHO Group 4, functional class I/II) and 9 healthy subjects free of cardiopulmonary disease. Single institution.

Intervention

4D flow MRI to assess right ventricular (RV) kinetic energy work density and viscous energy dissipation in the pulmonary artery (PA)

Comparator

Healthy subjects free of cardiopulmonary disease

Outcome

Right ventricular kinetic energy (KE) work density and percent pulmonary artery (PA) viscous energy losssurrogate

4D flow MRI reveals significantly increased right ventricular kinetic energy work density and pulmonary artery viscous energy loss in PAH patients, offering potential novel imaging markers for RV function.

Main Result

Absolute Event Rate: 94.7% vs 61.7%

p-value: p=0.007

Limitations

Small sample size
Time frames taken did not cover the complete cardiac cycle for a few bradycardiac healthy subjects
Median time of MRI was nearly two years after right heart catheterization
Three patients had comorbid diseases
Small patient population
Single institution
Tricuspid regurgitation was not measured due to high velocity encoding range needed
Did not account for the movement of the RV end systolic volume in work estimation
Energy loss estimation was performed only in the main pulmonary artery (MPA)

Abstract

The data contains human subject information that is limited to a small patient population in a single institution. On the IRB form, it clearly states that the data obtained from the patients will be stored on secure computers within the hospital of the University of Pennsylvania. Data are available upon request from the University of Pennsylvania Institutional Ethics Committee for researchers who meet the criteria for access to confidential data.

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