Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging: derivation and prospective validation study from the ASPIRE registry

JACC Cardiovasc Imaging. 2013 Oct;6(10):1036-1047. doi: 10.1016/j.jcmg.2013.01.013. Epub 2013 Jun 13.


Objectives: The aim of this study was to develop a composite numerical model based on parameters from cardiac magnetic resonance (CMR) imaging for noninvasive estimation of the key hemodynamic measurements made at right heart catheterization (RHC).

Background: Diagnosis and assessment of disease severity in patients with pulmonary hypertension is reliant on hemodynamic measurements at RHC. A robust noninvasive approach that can estimate key RHC measurements is desirable.

Methods: A derivation cohort of 64 successive, unselected, treatment naive patients with suspected pulmonary hypertension from the ASPIRE (Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Centre) Registry, underwent RHC and CMR within 12 h. Predicted mean pulmonary arterial pressure (mPAP) was derived using multivariate regression analysis of CMR measurements. The model was tested in an independent prospective validation cohort of 64 patients with suspected pulmonary hypertension. Surrogate measures of pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were estimated by left atrial volumetry and pulmonary arterial phase contrast imaging, respectively. Noninvasive pulmonary vascular resistance (PVR) was calculated from the CMR-derived measurements, defined as: (CMR-predicted mPAP - CMR-predicted PCWP)/CMR phase contrast CO.

Results: The following composite statistical model of mPAP was derived: CMR-predicted mPAP = -4.6 + (interventricular septal angle × 0.23) + (ventricular mass index × 16.3). In the validation cohort a strong correlation between mPAP and MR estimated mPAP was demonstrated (R(2) = 0.67). For detection of the presence of pulmonary hypertension the area under the receiver-operating characteristic (ROC) curve was 0.96 (0.92 to 1.00; p < 0.0001). CMR-estimated PVR reliably identified invasive PVR ≥3 Wood units (WU) with a high degree of accuracy, the area under the ROC curve was 0.94 (0.88 to 0.99; p < 0.0001).

Conclusions: CMR imaging can accurately estimate mean pulmonary artery pressure in patients with suspected pulmonary hypertension and calculate PVR by estimating all major pulmonary hemodynamic metrics measured at RHC.

Keywords: BSA; CMR; CO; LA; LV; PCWP; PH; PVR; RHC; ROC; RV; SA; SSFP; VMI; body surface area; cardiac magnetic resonance; cardiac output; cardiovascular magnetic resonance imaging; left atrial; left ventricle/ventricular; mPAP; mean pulmonary arterial pressure; pulmonary artery pressure; pulmonary capillary wedge pressure; pulmonary hypertension; pulmonary vascular resistance; receiver-operating characteristic; right heart catheterization; right ventricular; short axis; steady-state free precession; ventricular mass index.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Area Under Curve
  • Arterial Pressure*
  • Cardiac Catheterization
  • Chi-Square Distribution
  • Familial Primary Pulmonary Hypertension
  • Female
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / physiopathology
  • Linear Models
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prospective Studies
  • Pulmonary Artery / physiopathology*
  • Pulmonary Circulation*
  • ROC Curve
  • Registries
  • Reproducibility of Results
  • Severity of Illness Index
  • Vascular Resistance*