Journal Article

CMR fluoroscopy right heart catheterization for cardiac output and pulmonary vascular resistance: results in 102 patients

Lederman, Robert J., Kellman, Peter, Schenke, William H., Rogers, Toby, Mazal, Jonathan R., Grant, Elena K., Faranesh, Anthony Z., Khan, Jaffar M., Hansen, Michael S., Xue, Hui, Grant, Laurie P., Campbell-Washburn, Adrienne, Herzka, Daniel A., Ramasawmy, Rajiv, Stine, Annette, Ratnayaka, Kanishka

2017

Overview

Quantification of cardiac output and pulmonary vascular resistance (PVR) are critical components of invasive hemodynamic assessment, and can be measured concurrently with pressures using phase contrast CMR flow during real-time CMR guided cardiac catheterization. One hundred two consecutive patients underwent CMR fluoroscopy guided right heart catheterization (RHC) with simultaneous measurement of pressure, cardiac output and pulmonary vascular resistance using CMR flow and the Fick principle for comparison. Procedural success, catheterization time and adverse events were prospectively collected. RHC was successfully completed in 97/102 (95.1%) patients without complication. Catheterization time was 20 ± 11 min. In patients with and without pulmonary hypertension, baseline mean pulmonary artery pressure was 39 ± 12 mmHg vs. 18 ± 4 mmHg (p < 0.001), right ventricular (RV) end diastolic volume was 104 ± 64 vs. 74 ± 24 (p = 0.02), and RV end-systolic volume was 49 ± 30 vs. 31 ± 13 (p = 0.004) respectively. 103 paired cardiac output and 99 paired PVR calculations across multiple conditions were analyzed. At baseline, the bias between cardiac output by CMR and Fick was 5.9% with limits of agreement −38.3% and 50.2% with r = 0.81 (p < 0.001). The bias between PVR by CMR and Fick was −0.02 WU.m2 with limits of agreement −2.6 and 2.5 WU.m2 with r = 0.98 (p < 0.001). Correlation coefficients were lower and limits of agreement wider during physiological provocation with inhaled 100% oxygen and 40 ppm nitric oxide. CMR fluoroscopy guided cardiac catheterization is safe, with acceptable procedure times and high procedural success rate. Cardiac output and PVR measurements using CMR flow correlated well with the Fick at baseline and are likely more accurate during physiological provocation with supplemental high-concentration inhaled oxygen. Clinicaltrials.gov NCT01287026, registered January 25, 2011.

• Publisher: Elsevier Inc,BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Administration, Inhalation / Adult / Aged / Analysis / Anesthesia / Angiology / Bias / Cardiac Catheterization / Cardiac MRI / Cardiac Output / Cardiology / Case-Control Studies / Catheterization / Catheters / CMR / Congenital diseases / Correlation coefficients / Critical components / Female / Fluoroscopy / Heart / Heart catheterization / Heart rate / Hemodynamics / Humans / Hypertension, Pulmonary - diagnostic imaging / Hypertension, Pulmonary - physiopathology / Imaging / Interventional MRI catheterization / Intubation / Invasive hemodynamics / Ionizing radiation / Laboratories / Magnetic Resonance Imaging, Interventional / Male / Medical diagnosis / Medicine / Medicine & Public Health / Middle Aged / Models, Cardiovascular / Nitric oxide / Nitric Oxide - administration & dosage / NMR / Nuclear magnetic resonance / Oxygen / Oxygen - administration & dosage / Phase contrast / Phase contrast MRI flow / Predictive Value of Tests / Prospective Studies / Pulmonary arteries / Pulmonary artery / Pulmonary Artery - physiopathology / Pulmonary hypertension / Radiology / Real time / Real-time MRI / Right heart catheterization / Time Factors / Vascular Resistance / Veins & arteries