Magnetic Resonance Imaging in the Diagnosis of Pulmonary Hypertension

The aim of the present study is to identify changes in the cardiovascular system in patients with pulmonary hypertension (PH) by magnetic resonance imaging (MRI). MRI is accepted as golden standard method for the evaluation of left and right ventricular morphology and function.

All patients who showed elevated pulmonary pressure in the right heart catheter investigation are assigned to MRI. Parameters derived from MRI are included in the clinical and therapeutic decisions. Well established as well as new MRI parameters are evaluated and compared to the results of right heart catheter. Further age-matched controls without known cardiac or pulmonary disease are investigated by native MRI.

Study Overview

• Status: Completed
• Conditions: Pulmonary Hypertension; Ventricular Function; MR Phase Contrast Velocity Imaging; Late Enhancement Patterns

Detailed Description

Patients with suspected, latent and manifest PH and controls are investigated by MRI according to the following protocol in breathhold or free breathing (depending on the patients' breath-hold abilities). In case of elevated Creatinin values, no contrast agent is applied.

• Planning of cardiac views: Planning of 2-chamber view, short axes view and 4-chamber view.
• Morphological overview: Transversal and coronal Haste images
• Left and right heart functional and valve evaluation: Cine 2-chamber imaging, Multi-slice cine 4-chamber imaging, Cine Left and Right ventricular outflow tract imaging and Multi-slice cine short axes imaging covering the left and right ventricle for evaluation of EDV, ESV, SV, EF, CO and muscle mass.
• Phase Contrast Imaging: Flow measurements in the aorta, the pulmonary artery and the heart.
• Perfusion measurement.
• Late enhancement measurement: Multi-slice short axes view, multi-slice 2-chamber view and multi-slice 4-chamber view.

• Study Type: Observational
• Enrollment (Actual): 240

Contacts and Locations

Study Locations

• Austria
  • Stmk.
    • Graz, Stmk., Austria, 8036
      • Medical Unitersity Graz, University Clinic of Internal Medicine, Department of Pulmonology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Cardiac MR is recommended to all patients with suspected, latent and manifest PH who are investigated by right heat catheter in the Department of Pulmonology. Patients with pacemaker, agoraphobia or other standard MR contraindications are excluded from the study.

Description

Inclusion Criteria:

• Controls without history of cardiac or pulmonary diseases
• Patients with suspected PH
• Patients with latent PH
• Patients with manifest PH

Exclusion Criteria:

• MRI exclusion criteria

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
PulmoHypertension; Patients with suspected, latent or manifest pulmonary hypertension
Controls; Controls without history of cardiac or pulmonary diseases

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
right ventricular function	right ventricular end-diastolic volume (EDV), right ventricular end-systolic volume (ESV), right ventricular stroke volume (SV), right ventricular ejection fraction (EF), right ventricular cardiac output (CO), right ventricular muscle mass (RVMM)	at the MRI investigation

Collaborators and Investigators

• Sponsor: Medical University of Graz
• Investigators: Principal Investigator: Gabor Kovacs, MD, Medical Unitersity Graz, University Clinic of Internal Medicine, Department of Pulmonology; Principal Investigator: Ursula Reiter, PhD, Medical Unitersity Graz, University Clinic of Radiology, Department of General Radiological Diagnostics; Principal Investigator: Gert Reiter, PhD, Siemens Medical Austria; Principal Investigator: HOrst Olschewski, M.D., Medical University of Graz

Publications and helpful links

General Publications

• Reiter G, Reiter U, Kovacs G, Kainz B, Schmidt K, Maier R, Olschewski H, Rienmueller R. Magnetic resonance-derived 3-dimensional blood flow patterns in the main pulmonary artery as a marker of pulmonary hypertension and a measure of elevated mean pulmonary arterial pressure. Circ Cardiovasc Imaging. 2008 Jul;1(1):23-30. doi: 10.1161/CIRCIMAGING.108.780247.
• Reiter G, Kovacs G, Reiter C, Schmidt A, Fuchsjager M, Olschewski H, Reiter U. Left atrial acceleration factor as a magnetic resonance 4D flow measure of mean pulmonary artery wedge pressure in pulmonary hypertension. Front Cardiovasc Med. 2022 Aug 3;9:972142. doi: 10.3389/fcvm.2022.972142. eCollection 2022.
• Reiter U, Kovacs G, Reiter C, Krauter C, Nizhnikava V, Fuchsjager M, Olschewski H, Reiter G. MR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension. Eur Radiol. 2021 Apr;31(4):1883-1893. doi: 10.1007/s00330-020-07287-6. Epub 2020 Sep 24.
• Reiter G, Reiter U, Kovacs G, Olschewski H, Fuchsjager M. Blood flow vortices along the main pulmonary artery measured with MR imaging for diagnosis of pulmonary hypertension. Radiology. 2015 Apr;275(1):71-9. doi: 10.1148/radiol.14140849. Epub 2014 Nov 5.

Study record dates

Study Major Dates

• Study Start: December 1, 2006
• Primary Completion (Actual): December 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: December 17, 2007
• First Submitted That Met QC Criteria: December 17, 2007
• First Posted (Estimate): December 18, 2007

Study Record Updates

• Last Update Posted (Estimate): May 28, 2014
• Last Update Submitted That Met QC Criteria: May 27, 2014
• Last Verified: May 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Lung Diseases; Hypertension; Hypertension, Pulmonary
• Other Study ID Numbers: PH-06-CMR-01