CMR in the Diagnosis and Treatment of Pulmonary Hypertension

MT ROYAL, NJ— The country recently observed Pulmonary Hypertension (PH) Awareness Month, a month dedicated to raising awareness about the disease and available treatment.  Although the estimated prevalence of PH is 15-50 cases per million, its incidence in certain at-risk groups is substantially higher. PH cannot be cured but it can be managed, Cardiovascular Magnetic Resonance (CMR), a noninvasive technique free of ionizing radiation, is generating interest among  medical professionals as a viable modality for diagnosing and following PH patients. The Society for Cardiovascular Magnetic Resonance (SCMR) is committed to ensuring that as advances are made in using this modality to improve patient outcomes, the campaign to raise awareness about CMR as an effective modality is not confined to one month a year.

PH and CMR

PH is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation that, over time, causes vascular remodeling and increased pulmonary vascular resistance.

A PH diagnosis requires an evaluation of hemodynamic parameters via right-heart catheterization (RHC), an invasive procedure that is associated with a small risk of morbidity and mortality.

Advances in CMR technology have driven the development of noninvasive techniques for assessing cardiovascular structure and function—including hemodynamic parameters—which more accurately measure right ventricular morphologic changes. For these reasons, CMR is a promising modality for diagnosing and following patients with PH.

The Advantages of CMR

Typical information gained from a CMR study include: left and right ventricular (RV) size and function; late gadolinium enhancement (LGE) imaging to characterize the myocardial tissue and identify pathological processes within it; magnetic resonance angiography to evaluate the anatomy of the aorta, pulmonary artery and systemic/ pulmonary veins; and velocity encoded imaging to quantify shunt fractions, cardiac output, and pulmonary artery stiffness.

The RV structural and functional assessment plays a vital role in diagnosis and follow-up. Because the geometry of the RV is complex, it is difficult to evaluate its contractile motion and functional parameters with 2-dimensional echocardiography. The excellent image quality of the CMR provides a more accurate assessment.

A comprehensive CMR study also has the potential to differentiate between different categories of PH. Accurate categorization of PH is integral to disease management because treatment depends on the underlying etiology. For example, RV failure secondary to chronically elevated afterload is often the cause of death in pulmonary hypertension.

As a monitoring tool, a CMR can produce 3-D images that are far more detailed and precise but the procedure can be expensive and insurers may resist using the technology for screening purposes. However, this may not necessarily hold true in PH because patient monitoring and treatment decisions can have long term economic consequences that exceed the costs of a CMR examination, which can yield more detailed and accurate information.

SCMR President Matthias G. Friedrich, MD, FESC, FACC, said, ““Pulmonary Hypertension is a chronic and often devastating disease. We need better assessment and treatment modalities to better understand its early course and impact on the cardiovascular system. Therefore, CMR will become increasingly important.”

 

About SCMR

The Society for Cardiovascular Magnetic Resonance (SCMR) is the recognized representative and advocate for physicians, scientists, and technologists who work in the field of cardiovascular magnetic resonance (CMR). SCMR is the principal international, independent organization committed to the further development of CMR through education, quality control, research, and training.

Membership has grown to over 2,300 – which includes cardiologists, radiologists, technologists and administrators from around the world.

For more information, go to www.scmr.org.

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