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Background : Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure.
Methods : Consecutive clinically referred patients (n=60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5T (n=43) or 3T (n=17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity >2.8 m/s (TRPG >31 mmHg).
Results : Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p<0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R 2 =0.65, p<0.001).
Conclusions : There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.
Keywords
Magnetic Resonance Imaging, Pulmonary Hypertension, 4D Flow, Echocardiography
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CURRENT STATUS: Published
View the published article at BMC Medical Imaging.
No community comments so far
Editorial decision: Accept
On 24 Feb, 2020
Editor assigned
On 23 Feb, 2020
Submission checks complete
On 22 Feb, 2020
Editor invited
On 22 Feb, 2020
Version 2
Posted 20 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 22 Feb, 2020
Review #3 received
Received 09 Feb, 2020
Review #2 received
Received 05 Feb, 2020
Review #1 received
Received 31 Jan, 2020
Reviewer #3 agreed
On 25 Jan, 2020
Reviewer #1 agreed
On 21 Jan, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Reviewers invited
Invitations sent on 20 Jan, 2020
Editor assigned
On 16 Jan, 2020
Submission checks complete
On 15 Jan, 2020
Editor invited
On 15 Jan, 2020
No comments provided
Editorial decision: Major revision
On 18 Dec, 2019
Review #2 received
Received 17 Dec, 2019
Review #1 received
Received 15 Dec, 2019
Reviewer #2 agreed
On 04 Dec, 2019
Reviewers invited
Invitations sent on 22 Oct, 2019
Reviewer #1 agreed
On 22 Oct, 2019
Submission checks complete
On 27 Sep, 2019
Editor assigned
On 27 Sep, 2019
Editor invited
On 26 Sep, 2019
First submitted
On 25 Sep, 2019
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PDF Downloads: ...
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Subject Areas
Nuclear Medicine & Medical Imaging
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See the published version of this preprint at BMC Medical Imaging.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Medical Imaging.
No community comments so far
Editorial decision: Accept
On 24 Feb, 2020
Editor assigned
On 23 Feb, 2020
Submission checks complete
On 22 Feb, 2020
Editor invited
On 22 Feb, 2020
Version 2
Posted 20 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 22 Feb, 2020
Review #3 received
Received 09 Feb, 2020
Review #2 received
Received 05 Feb, 2020
Review #1 received
Received 31 Jan, 2020
Reviewer #3 agreed
On 25 Jan, 2020
Reviewer #1 agreed
On 21 Jan, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Reviewers invited
Invitations sent on 20 Jan, 2020
Editor assigned
On 16 Jan, 2020
Submission checks complete
On 15 Jan, 2020
Editor invited
On 15 Jan, 2020
No comments provided
Editorial decision: Major revision
On 18 Dec, 2019
Review #2 received
Received 17 Dec, 2019
Review #1 received
Received 15 Dec, 2019
Reviewer #2 agreed
On 04 Dec, 2019
Reviewers invited
Invitations sent on 22 Oct, 2019
Reviewer #1 agreed
On 22 Oct, 2019
Submission checks complete
On 27 Sep, 2019
Editor assigned
On 27 Sep, 2019
Editor invited
On 26 Sep, 2019
First submitted
On 25 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nuclear Medicine & Medical Imaging
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Medical Imaging.
Background : Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure.
Methods : Consecutive clinically referred patients (n=60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5T (n=43) or 3T (n=17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity >2.8 m/s (TRPG >31 mmHg).
Results : Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p<0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R 2 =0.65, p<0.001).
Conclusions : There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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