Pulmonary Hypertension and the Role of MRI Flow Assessment: A Systematic Review.

Objectives: Cardiac magnetic resonance imaging (CMR) plays an increasingly important role in non-invasive assessment of pulmonary hypertension (PH). This systematic review aimed to assess the utility, accuracy and clinical applications of CMR flow techniques in evaluating pulmonary arterial blood flow in patients with suspected or confirmed PH.

Methods: MEDLINE and EMBASE databases were searched on 10 December 2024, utilising the following key terms: 'cardiac MRI', 'flow', and 'pulmonary hypertension'.

Lung parenchymal and cardiac appearances on computed tomography pulmonary angiography impact survival in chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is commonly evaluated using computed tomography pulmonary angiography (CTPA). We evaluated the frequency and impact of parenchymal and cardiac abnormalities on survival in CTEPH.

Methods: Patients were identified from the ASPIRE (Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Centre) Registry.

Cardiac MRI-derived mean right atrial pressure and its prognostic importance.

Background: Right atrial pressure (RAP) is a key variable that cardiac MRI (CMR) cannot currently measure. We aimed to develop a model to estimate mean RAP (mRAP) using CMR and assess the prognostic value of CMR-derived mRAP in an independent patient cohort.

Methods: The derivation cohort consisted of patients investigated for heart failure symptoms with right heart catheterisation and CMR.

Xe-MRI ventilation and acinar abnormalities highlight the significance of spirometric dysanapsis: findings from the NOVELTY ADPro UK substudy.

Rationale: Airways dysanapsis is defined by CT or spirometry as a mismatch between the size of the airways and lung volume and is associated with increased risk of developing chronic obstructive pulmonary disease (COPD). Lung disease in participants with dysanapsis and a label of asthma and/or COPD remains poorly understood.

Methods: In participants with asthma and/or COPD, we used Xe-MRI to assess ventilation, acinar dimensions and gas exchange, and pulmonary function tests, and compared people with spirometric dysanapsis (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)<-1.

Artificial intelligence-based echocardiography assessment to detect pulmonary hypertension.

Background: Tricuspid regurgitation jet velocity (TRJV) on echocardiography is used for screening patients with suspected pulmonary hypertension (PH). Artificial intelligence (AI) tools, such as the US2.AI, have been developed for automated evaluation of echocardiograms and can yield measurements that aid PH detection.

Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis.

Aims: Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V), grading AS severity and predicting AV intervention in a real-world setting.

Methods: Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included.

Cardiovascular magnetic resonance imaging markers of ageing: a multi-centre, cross-sectional cohort study.

Aims: Cardiac ageing involves a series of anatomical and physiological changes contributing to a decline in overall performance. Cardiac magnetic resonance (CMR) provides comprehensive structural and functional assessment for detecting age-related cardiovascular remodelling. We aimed to develop a fully automated CMR model to predict functional heart age.

CT Emphysema Subtypes and Cardiac Hemodynamics Estimated on MRI: The Multi-Ethnic Study of Atherosclerosis COPD Study.

Background: COPD is traditionally associated with pulmonary hypertension, but treatments targeting elevated pulmonary artery pressure in COPD have largely failed, possibly due to an incomplete understanding of subphenotypes of the disease.

Research Question: Are novel machine-learned CT emphysema subtypes associated with specific cardiac hemodynamic profiles?

Study Design And Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited participants with and without COPD aged 50 to 79 years with ≥ 10 pack-years of smoking and without clinical cardiovascular disease, predominantly from MESA and a lung cancer screening cohort. COPD and COPD severity were defined by standard spirometric criteria.

Mean pulmonary artery pressure prediction with explainable multi-view cardiovascular magnetic resonance cine series deep learning model.

Background: Pulmonary hypertension (PH) is a heterogeneous condition and regardless of etiology impacts negatively on survival. Diagnosis of PH is based on hemodynamic parameters measured invasively at right heart catheterization (RHC); however, a non-invasive alternative would be clinically valuable. Our aim was to estimate RHC parameters non-invasively from cardiac magnetic resonance (MR) data using deep learning models and to identify key contributing imaging features.

Automated Quantification of Simple and Complex Aortic Flow Using 2D Phase Contrast MRI.

(1) : Flow assessment using cardiovascular magnetic resonance (CMR) provides important implications in determining physiologic parameters and clinically important markers. However, post-processing of CMR images remains labor- and time-intensive. This study aims to assess the validity and repeatability of fully automated segmentation of phase contrast velocity-encoded aortic root plane.

Do Hemodynamic Definitions of Chronic Thromboembolic Pulmonary Hypertension Distinguish between Distinct Phenotypes of Chronic Thromboembolic Pulmonary Disease?

Chronic thromboembolic pulmonary disease (CTEPD) is defined by chronic organized thrombi in the pulmonary circulation without or with pulmonary hypertension. The current definition of chronic thromboembolic pulmonary hypertension (CTEPH) has adopted lower mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) thresholds. Our aim was to identify its impact on the characterization of patients with CTEPD.

Meta-Analysis of Interobserver Agreement in Assessment of Interstitial Lung Disease Using High-Resolution CT.

Background High-resolution CT (HRCT) is central to the assessment of interstitial lung disease (ILD), and accurate classification of disease has important implications for patients. Evaluation of imaging features can be challenging, even for experienced thoracic radiologists. Previous work has provided equivocal evidence on the interpretation of HRCT features at ILD-related imaging.

The spectrum of systemic sclerosis-associated pulmonary hypertension: Insights from the ASPIRE registry.

Background: There are limited data assessing the spectrum of systemic sclerosis-associated pulmonary hypertension (PH).

Methods: Data for 912 systemic sclerosis patients assessed between 2000 and 2020 were retrieved from the Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre (ASPIRE) registry and classified based on 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines and multimodality investigations.

Results: Reduction in pulmonary vascular resistance (PVR) diagnostic threshold to >2WU resulted in a 19% increase in precapillary PH diagnoses.

Transcriptional profiling unveils molecular subgroups of adaptive and maladaptive right ventricular remodeling in pulmonary hypertension.

Right ventricular (RV) function is critical to prognosis in all forms of pulmonary hypertension. Here we perform molecular phenotyping of RV remodeling by transcriptome analysis of RV tissue obtained from 40 individuals, and two animal models of RV dysfunction of both sexes. Our unsupervised clustering analysis identified 'early' and 'late' subgroups within compensated and decompensated states, characterized by the expression of distinct signaling pathways, while fatty acid metabolism and estrogen response appeared to underlie sex-specific differences in RV adaptation.

Formation of uranium disulfide from a uranium thioamidate single-source precursor.

A single-source-precursor approach was developed to synthesize uranium-based materials outside of the typically-studied oxides. This approach allows for shorter reaction times, milder reaction conditions, and control over the chemicals present in synthesis. To this end, the first homoleptic uranium thioamidate complex was synthesized as a precursor for US materials.

Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study.

Background: Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH).

Development and validation of AI-derived segmentation of four-chamber cine cardiac magnetic resonance.

Background: Cardiac magnetic resonance (CMR) in the four-chamber plane offers comprehensive insight into the volumetrics of the heart. We aimed to develop an artificial intelligence (AI) model of time-resolved segmentation using the four-chamber cine.

Methods: A fully automated deep learning algorithm was trained using retrospective multicentre and multivendor data of 814 subjects.

Applications of artificial intelligence in computed tomography imaging for phenotyping pulmonary hypertension.

Purpose Of Review: Pulmonary hypertension is a heterogeneous condition with significant morbidity and mortality. Computer tomography (CT) plays a central role in determining the phenotype of pulmonary hypertension, informing treatment strategies. Many artificial intelligence tools have been developed in this modality for the assessment of pulmonary hypertension.

Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure.

Aims: Heart failure (HF) with preserved ejection fraction disproportionately affects women. There are no validated sex-specific tools for HF diagnosis despite widely reported differences in cardiac structure. This study investigates whether sex, as assigned at birth, influences cardiac magnetic resonance (CMR) assessment of left ventricular filling pressure (LVFP), a hallmark of HF agnostic to ejection fraction.

Age, sex, and lung volume dependence of dissolved xenon-129 MRI gas exchange metrics.

Purpose: To characterize the dependence of Xe-MRI gas transfer metrics upon age, sex, and lung volume in a group of healthy volunteers.

Methods: Sixty-five subjects with no history of chronic lung disease were assessed with Xe-MRI using a four-echo 3D radial spectroscopic imaging sequence and a dose of xenon titrated according to subject height that was inhaled from a lung volume of functional residual capacity (FRC). Imaging was repeated in 34 subjects at total lung capacity (TLC).

Validation of Left Atrial Volume Correction for Single Plane Method on Four-Chamber Cine Cardiac MRI.

Background: Left atrial (LA) assessment is an important marker of adverse cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) accurately quantifies LA volume and function based on biplane long-axis imaging. We aimed to validate single-plane-derived LA indices against the biplane method to simplify the post-processing of cine CMR.

Characterisation of the octogenarians presenting to the diagnostic heart failure clinic: SHEAF registry.

Introduction: Heart failure (HF) incidence is increasing in older adults with high hospitalisation and mortality rates. Treatment is complicated by side effects and comorbidities. We investigated the clinical characteristics of octogenarians presenting to the HF clinic.

Aortic flow is abnormal in HFpEF.

Aims: Turbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF.