Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients
Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with balloon pulmonary angioplasty (BPA) in inoperable patients. Sensitive non-invasive imaging methods are missing to detect treatment response after a single BPA treatment session. Therefore, the aim of this study was to measure treatment response after a single BPA session using cardio-pulmonary MRI.
Materials and methods
Overall, 29 patients with CTEPH were examined with cardio-pulmonary MRI before and 62 days after their initial BPA session. Pulmonary blood flow (PBF), first-pass bolus kinetic parameters, and biventricular mass and function were determined. Multiple linear regression analysis was implemented to estimate the relationship of PBF change in the treated lobe with treatment change of full width at half maximum (FWHM), cardiac output (CO), ventricular mass index (VMI), pulmonary transit time (PTT) and PBF change in the non-treated lobes. Paired Wilcoxon rank sum test and Spearman rho correlation were used.
After BPA regional PBF increased in the treated lobe (p < 0.0001) as well as in non-treated lobes (p = 0.015). PBF treatment changes in the treated lobe were significantly larger compared with the non-treated lobes (p = 0.0049). Change in NT proBNP, MRI-derived mean pulmonary artery pressure (mPAP), PTT, FWHM, right ventricular (RV) ejection fraction, RV stroke volume, CO, VMI and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05). PBF changes in the treated lobe were independently predicted by PTT as well as PBF change in the non-treated lobes.
Cardio-pulmonary MRI detects and quantifies treatment response after a single BPA treatment session.
• Two months after BPA regional parenchymal pulmonary perfusion (PBF) increased in the total lung parenchyma (p = 0.005), the treated lobes (p < 0.0001) and non-treated lobes (p = 0.015).
• The PBF treatment changes in the treated lobe were significantly larger than in the non-treated lobes (p = 0.0049).
• Change in NT proBNP, MRI-derived mean pulmonary artery pressure, pulmonary transit time, full width at half maximum, right ventricular (RV) ejection fraction, RV stroke volume, cardiac output, ventricular mass index and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05).
KeywordsPulmonary hypertension Balloon angioplasty Perfusion Heart Magnetic resonance imaging
Six-minute walking distance
Balloon pulmonary angioplasty
Body surface area
Chronic thromboembolic pulmonary hypertension
Dynamic contrast enhanced
Full width at half maximum
Mean pulmonary artery pressure
N-terminal pro B-type natriuretic peptide
- NYHA FC
New York Heart Association functional classification
Pulmonary blood flow
Pulmonary transit time
Pulmonary vascular resistance
Right-sided heart catheterization
Time to peak
Time-resolved angiography with stochastic trajectories
Ventricular mass index
This study has received funding from the German Center for Lung Research (DZL).
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Dr. Jens Vogel-Claussen.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
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