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1 Cardiac MR Research Group, Division of Imaging Sciences, Kings College London, London, London, United Kingdom
2 Cardiac MR Research Group, Division of Imaging Sciences, Kings College London, London, London, United Kingdom; Cardiothoracic Unit, Institute of Child Health and Great Ormond Street Hospital, London, London, United Kingdom
3 Dept of Congenital Heart Disease, Guys Hospital, London, London, United Kingdom
4 Cardiac MR Research Group, Division of Imaging Sciences, Kings College London, London, London, United Kingdom; Dept of Congenital Heart Disease, Guys Hospital, London, London, United Kingdom
* To whom correspondence should be addressed. E-mail: reza.razavi{at}kcl.ac.uk.
Pulmonary hypertensive disease is currently assessed by quantification of pulmonary vascular resistance. Pulmonary total arterial compliance is also an indicator of pulmonary hypertensive disease. However, due to difficulties in measuring compliance it is rarely used. We describe a method of measuring pulmonary arterial compliance utilizing magnetic resonance (MR) flow data and invasive pressure measurements. Seventeen patients with either suspected pulmonary hypertension or congenital heart disease requiring pre-operative assessment underwent MR guided cardiac catheterisation. Invasive manometry was used to measure pulmonary artery pressure, and phase contrast MR was used to measure flow at baseline and at 20ppm of nitric oxide (NO). Total arterial compliance was calculated using the pulse pressure method (parameter optimization of the 2 element Windkessel model) and using the ratio of stroke volume to pulse pressure. There was good agreement between to the two estimates of compliance (r=0.98, p<0.001). However, there was a systematic bias between the ratio of stroke volume to pulse pressure and the pulse pressure method compliance (bias=61%, upper level of agreement=84%, lower level of agreement=38%). In response to 20ppm of NO, there was a statistically significant fall in resistance, systolic pressure and pulse pressure. In seven patients total arterial compliance increased >10% in response to 20ppm of NO. As a population the increase did not reach statistical significance. There was an inverse relationship between compliance, and resistance (r=0.89, p<0.001) and mean pulmonary arterial pressure (r=0.72, p<0.001). We have demonstrated the feasibility of quantifying total arterial compliance using a MR method.
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