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Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension

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Abstract
Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e(-8)). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63-100%] and specificity of 91% (95% CI 75-98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.
Keywords
MAGNETIC-RESONANCE, PRESSURE, VELOCITY, REFLECTION, SPEED, MRI, THROMBOEMBOLISM, SEPARATION, DIAGNOSIS, AORTA, pulmonary hypertension, hemodynamics, wave intensity, cardiac magnetic resonance imaging

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Chicago
Quail, Michael A, Daniel S Knight, Jennifer A Steeden, Liesbeth Taelman, Shahin Moledina, Andrew M Taylor, Patrick Segers, J Gerry Coghlan, and Vivek Muthurangu. 2015. “Noninvasive Pulmonary Artery Wave Intensity Analysis in Pulmonary Hypertension.” American Journal of Physiology-heart and Circulatory Physiology 308 (12): H1603–H1611.
APA
Quail, M. A., Knight, D. S., Steeden, J. A., Taelman, L., Moledina, S., Taylor, A. M., Segers, P., et al. (2015). Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 308(12), H1603–H1611.
Vancouver
1.
Quail MA, Knight DS, Steeden JA, Taelman L, Moledina S, Taylor AM, et al. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY. 2015;308(12):H1603–H1611.
MLA
Quail, Michael A, Daniel S Knight, Jennifer A Steeden, et al. “Noninvasive Pulmonary Artery Wave Intensity Analysis in Pulmonary Hypertension.” AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY 308.12 (2015): H1603–H1611. Print.
@article{7006692,
  abstract     = {Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35\% CTEPH and 75\% female) and 10 healthy controls (60\% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e(-8)). The area under the BCW was associated with a sensitivity of 100\% [95\% confidence interval (CI) 63-100\%] and specificity of 91\% (95\% CI 75-98\%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.},
  author       = {Quail, Michael A and Knight, Daniel S and Steeden, Jennifer A and Taelman, Liesbeth and Moledina, Shahin and Taylor, Andrew M and Segers, Patrick and Coghlan, J Gerry and Muthurangu, Vivek},
  issn         = {0363-6135},
  journal      = {AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY},
  keyword      = {MAGNETIC-RESONANCE,PRESSURE,VELOCITY,REFLECTION,SPEED,MRI,THROMBOEMBOLISM,SEPARATION,DIAGNOSIS,AORTA,pulmonary hypertension,hemodynamics,wave intensity,cardiac magnetic resonance imaging},
  language     = {eng},
  number       = {12},
  pages        = {H1603--H1611},
  title        = {Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension},
  url          = {http://dx.doi.org/10.1152/ajpheart.00480.2014},
  volume       = {308},
  year         = {2015},
}

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