Background

Cardiac magnetic resonance (CMR) is a promising noninvasive tool for assessing pulmonary arterial hypertension (PAH). This study aimed to estimate mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) based on CMR metrics using right heart catheterization (RHC) as the gold standard in connective tissue disease-associated PAH (CTD-PAH).

Methods

This study retrospectively enrolled 70 consecutive patients diagnosed with CTD-PAH who underwent both CMR and RHC within seven days between September 2017 and April 2023. Their ventricular volumes, functions, and morphology; T1 mapping parameters; and main pulmonary artery (MPA) hemodynamics were measured. The correlations between CMR and RHC parameters were assessed using Spearman’s rank correlation coefficient (rs). The thresholds of mPAP changes were identified using segmental linear regression analysis, and predictive models were developed for mPAP and PVR using regression analysis.

Results

The mPAP was strongly correlated with ventricular mass index (VMI; rs = 0.74), interventricular septal (IVS; rs= 0.72) angle, and IVS curvature (rs = −0.71; all P < 0.01). The PVR was strongly positively correlated with VMI (rs = 0.72, P < 0.01). Segmented linear regression identified a right ventricular ejection fraction (RVEF) threshold of 21%. When the RVEF was > 21%, VMI, septum to free-wall distance change (SFD), IVS curvature, and the MPA/ascending aorta (AAo) diameter ratio were independently correlated with mPAP (P < 0.05). A CMR model for predicting mPAP was established: 31.167 + (16.400 × VMI) – (19.254 × IVS curvature) – (6.971 × SFD) + (10.709 × MPA/AAo diameter ratio). Another CMR model for predicting PVR was developed: 11.798 + (16.723 × VMI) – (10.662 × IVS curvature) – (0.045 × right ventricular end-systolic volume index) – (5.074 × right ventricular stroke volume to end-systolic volume).

Conclusions

CMR parameters can be used to estimate mPAP and PVR in patients with CTD-PAH, potentially providing a noninvasive method for assessing pulmonary arterial hemodynamics during CTD-PAH management.

Acknowledgements

No acknowledgement found.

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