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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

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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J. Am. Coll. Cardiol. 2008 52: A33. [Full Text] [PDF]