MRI Prediction of Precapillary Pulmonary Hypertension According to the Sixth World Symposium on Pulmonary Hypertension

HomeRadiologyVol. 294, No. 2 PreviousNext CommunicationsFree AccessLetters to the EditorMRI Prediction of Precapillary Pulmonary Hypertension according to the Sixth World Symposium on Pulmonary HypertensionAndrew J. Whitfield* , Roshni Solanki*, Christopher S. Johns†, David Kiely†, Jim Wild‡, Andrew J. Swift‡Andrew J. Whitfield* , Roshni Solanki*, Christopher S. Johns†, David Kiely†, Jim Wild‡, Andrew J. Swift‡Author AffiliationsUniversity of Sheffield, Beech Hill Rd, Sheffield S10 2TN, England*Departments of Infection, Immunity and Cardiovascular Disease,† andDepartment of Academic Radiology,‡ University of Sheffield, Beech Hill Rd, Sheffield S10 2TN, Englande-mail: [email protected]Andrew J. Whitfield* Roshni Solanki*Christopher S. Johns†David Kiely†Jim Wild‡Andrew J. Swift‡Published Online:Dec 31 2019https://doi.org/10.1148/radiol.2019192078MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Editor:The Sixth World Symposium on Pulmonary Hypertension recommends that precapillary pulmonary hypertension (PH) be defined by a mean pulmonary artery pressure (mPAP) of greater than 20 mm Hg as well as a pulmonary vascular resistance (PVR) of at least 3 Woods units (WU) (1). Herein, we update the results from our article published in the January 2019 issue of Radiology (2) to reflect this new threshold. In our study, we derived two regression models based on cardiopulmonary vascular MRI measurements to predict mPAP in a population of patients with suspected PH from the ASPIRE registry (Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Center). At repeat analysis, the specificity of these models was reduced by the inclusion of PVR as a diagnostic indicator of PH. Therefore, in the same cohort, we now propose a new model using binary logistical regression to detect precapillary PH by using the new definition of mPAP greater than 20 mm Hg and a PVR of at least 3 WU.Of the 603 patients in our study, PVR data were not available for 52 (9%). In the derivation cohort (n = 270), 240 patients had precapillary PH. Using the derivation cohort, we generated a new cardiac MRI-based model using binary logistic regression to predict mPAP greater than 20 mm Hg and PVR of at least 3 WU. The following regression equation was identified: precapillary PH status (arbitrary units) = −27.7 + 5.75loge(interventricular septal angle [degree of arc]) + 1.899loge(right ventricular mass/left ventricular mass) + 0.004 (diastolic pulmonary artery area [in square millimeters]). A value of greater than 1 was diagnostic of precapillary PH at receiver operating characteristic analysis.In the validation cohort (n = 281) of 260 patients with PH and 21 patients without PH, the model had an area under the receiver operating characteristic curve of 0.93 (95% confidence interval [CI]: 0.89, 0.97). From the 2 × 2 contingency table analysis, the sensitivity, specificity, positive predictive value, and negative predictive value were 80% (202 of 252 patients; 95% CI: 75%, 95%), 90% (18 of 20 patients; 95% CI: 67%, 98%), 99% (202 of 204 patients; 95% CI: 96%, 100%), and 27% (18 of 68 patients; 95% CI: 17%, 39%), respectively. Further work to validate this equation in larger populations in the tertiary referral setting and in screening populations with larger numbers of patients without PH is now necessary.In conclusion, for identification of patients with mPAP greater than 20 mm Hg and PVR of at least 3 WU, we recommend the use of this new cardiopulmonary vascular MRI regression model.Disclosures of Conflicts of Interest: A.J.W. disclosed no relevant relationships. R.S. disclosed no relevant relationships. C.S.J. disclosed no relevant relationships. D.K. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives payment for board membership from Actelion, Bayer, and GlaxoSmithKline; received consultancy fees from Actelion, Bayer, and GlaxoSmithKline; institution has grants/grants pending from Actelion and GlaxoSmithKline; receives payment for lectures including service on speakers bureaus from Actelion, Bayer, GlaxoSmithKline, and Merk Sharp & Dohme; received travel/accommodations/meeting expenses from Actelion and GlaxoSmithKline; received payment for development of educational presentations from Actelion. Other relationships: disclosed no relevant relationships. J.W. disclosed no relevant relationships. A.J.S. disclosed no relevant relationships.References1. Galiè N, McLaughlin VV, Rubin LJ, Simonneau S. An overview of the 6th World Symposium on Pulmonary Hypertension. Eur Respir J 2019;53:1802148. Crossref, Medline, Google Scholar2. Johns CS, Kiely DG, Rajaram S, et al. Diagnosis of Pulmonary Hypertension with Cardiac MRI: Derivation and Validation of Regression Models. Radiology 2019;290(1):61–68. Link, Google ScholarArticle HistoryPublished online: Dec 31 2019Published in print: Feb 2020 FiguresReferencesRelatedDetailsCited ByNon-invasive detection of severe PH in lung disease using magnetic resonance imagingDheyaaAlkhanfar, KritDwivedi, FaisalAlandejani, YousefShahin, SamerAlabed, ChrisJohns, PankajGarg, A. A. RogerThompson, Alexander M. 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