Real-time magnetic resonance assessment of minimum septal curvature strongly correlated with mean pulmonary artery pressure at baseline (r=-0.81, P<0.01) and during vasodilator testing.
Observational (n=50)
Does real-time cardiovascular magnetic resonance assessment of septal curvature accurately estimate right ventricular afterload and track acute hemodynamic changes in pediatric pulmonary hypertension?
Real-time cardiovascular magnetic resonance assessment of septal curvature strongly correlates with invasive hemodynamics and can accurately identify vasoresponders in pediatric pulmonary hypertension.
Effect estimate: r=-0.81
p-value: p=<0.01
BACKGROUND: This study assesses the relationship between septal curvature and mean pulmonary artery pressure and indexed pulmonary vascular resistance in children with pulmonary hypertension. We hypothesized that septal curvature could be used to estimate right ventricular afterload and track acute changes in pulmonary hemodynamics. METHODS AND RESULTS: Fifty patients with a median age of 6.7 years (range, 0.45-16.5 years) underwent combined cardiac catheterization and cardiovascular magnetic resonance. The majority had idiopathic pulmonary arterial hypertension (n=30); the remaining patients had pulmonary hypertension associated with repaired congenital heart disease (n=17) or lung disease (n=3). Mean pulmonary artery pressure and pulmonary vascular resistance were acquired at baseline and during vasodilation. Septal curvature was measured using real-time cardiovascular magnetic resonance. There was a strong correlation between mean pulmonary artery pressure and SCmin at baseline and during vasodilator testing (r=-0.81 and -0.85, respectively; P<0.01). A strong linear relationship also existed between pulmonary vascular resistance and minimum septal curvature indexed to cardiac output both at baseline and during vasodilator testing (r=-0.88 and -0.87, respectively; P<0.01). Change in septal curvature metrics moderately correlated with absolute change in mean pulmonary artery pressure and pulmonary vascular resistance, respectively (r=0.58 and -0.74; P<0.01). Septal curvature metrics were able to identify vasoresponders with a sensitivity of 83% (95% confidence interval, 0.36-0.99) and a specificity of 91% (95% confidence interval, 0.77-0.97), using the Sitbon criteria. Idiopathic pulmonary arterial hypertension subgroup analysis revealed 3 responders with ΔSCmin values of 0.523, 0.551, and 0.568. If the middle value of 0.551 is taken as a cutoff, the approximate sensitivity would be 67% and the specificity would be 93%. CONCLUSIONS: Septal curvature metrics are able to estimate right ventricular afterload and track acute changes in pulmonary hemodynamics during vasodilator testing. This suggests that septal curvature could be used for continuing assessment of load in pulmonary hypertension.
Pandya et al. (Sat,) conducted a observational in Pulmonary hypertension (n=50). Real-time cardiovascular magnetic resonance assessment of septal curvature was evaluated on Correlation between mean pulmonary artery pressure and minimum septal curvature at baseline (r=-0.81, p=<0.01). Real-time magnetic resonance assessment of minimum septal curvature strongly correlated with mean pulmonary artery pressure at baseline (r=-0.81, P<0.01) and during vasodilator testing.