STATE-OF-THE-ART PAPER
Role of Cardiac Magnetic Resonance Imaging in the Management of Patients With Pulmonary Arterial Hypertension
Raymond Benza, MD*,*,
Robert Biederman, MD*,
Srinivas Murali, MD* and
Himanshu Gupta, MD
* Allegheny General Hospital, Pittsburgh, Pennsylvania
University of Alabama at Birmingham, Birmingham, Alabama
Manuscript received January 11, 2008;
revised manuscript received June 27, 2008,
accepted August 13, 2008.
* Reprint requests and correspondence: Dr. Raymond L. Benza, Allegheny General Hospital, 320 East North Avenue, 16th Floor, South Tower, Pittsburgh, Pennsylvania 15212 (Email: rbenza{at}wpahs.org).
Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation that results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance. Recent advances in magnetic resonance imaging (MRI) technology have led to the development of techniques for noninvasive assessment of cardiovascular structure and function, including hemodynamic parameters in the pulmonary circulation, which are superior in their identification of right ventricular morphologic changes. These advantages make cardiac MRI an attractive modality for following up and providing prognoses in patients with PAH. In this review, we summarize recent developments in the use of MRI for the diagnosis, assessment, and ongoing monitoring of patients with PAH. Over the coming decade, it can be anticipated that continued improvements in MRI image acquisition, spatial and temporal resolution, and analytical techniques will result in improved understanding of PAH pathophysiology, diagnosis, and prognostic variables, and will supplement, and may even replace, some of the invasive procedures currently applied routinely to the evaluation of PAH.
Key Words: echocardiography • magnetic resonance imaging • pulmonary heart disease • remodeling
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Abbreviations and Acronyms
| | cMRI = cardiac magnetic resonance imaging | | CTEPH = chronic thromboembolic pulmonary arterial hypertension | | DCE = delayed contrast enhancement | | IPAH = idiopathic pulmonary arterial hypertension | | LV = left ventricle/ventricular | | mPAP = mean pulmonary artery pressure | | MRI = magnetic resonance imaging | | PA = pulmonary artery/arterial | | PAH = pulmonary arterial hypertension | | PVR = pulmonary vascular resistance | | RHC = right heart catheterization | | RV = right ventricular/ventricle | | sPAP = systolic pulmonary artery pressure | | VMI = ventricular mass index |
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