Evaluation of Pulmonary Artery Stiffness in Pulmonary Hypertension with Cardiac Magnetic Resonance

OBJECTIVES: This study sought to evaluate indexes of pulmonary artery (PA) stiffness in patients with pulmonary hypertension (PH) using same-day cardiac magnetic resonance (CMR) and right heart catheterization (RHC). Background: Pulmonary artery stiffness is increased in the presence of PH, although the relationship to PH severity has not been fully characterized.

METHODS: Both CMR and RHC were performed on the same day in 94 patients with known or suspected PH. According to the RHC, patients were classified as having no PH (n = 13), exercise-induced PH (EIPH) only (n = 6), or PH at rest (n = 75). On CMR, phase-contrast images were obtained perpendicular to the pulmonary trunk. From CMR and RHC data, PA areas and indexes of stiffness (pulsatility, compliance, capacitance, distensibility, elastic modulus, and the pressure-independent stiffness index beta) were measured at rest.

RESULTS: All quantified indexes showed increased PA stiffness in patients with PH at rest in comparison with those with EIPH or no PH. Despite the absence of significant differences in baseline pressures, patients with EIPH had lower median compliance and capacitance than patients with no PH: 15 (interquartile range: 9 to 19.8) mm2/mm Hg versus 8.4 (interquartile range: 6 to 10.3) mm2/mm Hg, and 5.2 (interquartile range: 4.4 to 6.3) mm3/mm Hg versus 3.7 (interquartile range: 3.1 to 4.1) mm3/mm Hg, respectively (p < 0.05). The different measurements of PA stiffness, including stiffness index beta, showed significant correlations with PA pressures (r2 = 0.27 to 0.73). Reduced PA pulsatility (<40%) detected the presence of PH at rest with a sensitivity of 93% and a specificity of 63%.

CONCLUSIONS: Pulmonary artery stiffness increases early in the course of PH (even when PH is detectable only with exercise and before overt pressure elevations occur at rest). These observations suggest a potential contributory role of PA stiffness in the development and progression of PH.

PMID: 19356573

Jacobo Kirsch

Associate Center Director, Imaging Institute
Cardiopulmonary Imaging, Section Head
Cleveland Clinic Florida
Weston, FL
Posted in Magnetic Resonance Imaging and tagged , , , .


  1. Very well designed study with a sizable cohort of patients with pulmonary HTN that underwent right-heart catheterization, and cardiac MRI within a few hours of each other. The authors showed that a value of PA pulsatility <40% can detect the presence of PH at rest with a high sensitivity.
    Another interesting finding was that despite recording similar pulmonary pressures and resistance, subjects with exercise-induced pulmonary HTN had lower compliance and capacitance then patients with no HTN.

    An editorial comment accompanies this paper.

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