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Assessment of pulmonary hypertension by cardiac MRI and right sided heart catheter in COPD patients


Journal of Lung, Pulmonary & Respiratory Research
Tamer M Ibraheem,1 Aya M Abdel Dayem,1 Ayman Farghaly,2 Dalia Abd El Sattar El Embaby1

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Abstract

Background: Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation which results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance (PVR). Recent advances in cMRI technology have led to the development of techniques for noninvasive assessment of the morphology of the right side of the heart to be correlated to the hemodynamic parameters collected by RHC which is still the golden standard technique of PH diagnosis. Aim: To assess the role of Cardiac MRI in severe COPD patients with pulmonary artery pressure more than 35 mmHg as evaluated by Echocardiography and right sided cardiac catheterization. Patients and methods: The current study was conducted upon 20 patients with moderate or severe chronic obstructive pulmonary disease (COPD) by spirometry according to GOLD 2022 criteria who had been assessed for severe pulmonary hypertension with Pulmonary Artery Pressure more than 35 mmHg by cardiac Magnetic resonance imaging (cMRI) and right sided heart catheter (RHC). They were recruited from the outpatient clinic and department of chest specialized hospital Kobry Elkobba Armed Forces. Results: Twenty patients included in the study were 90% males, mean age about 64.50 ± 7.94 years old with mean smoking duration 33.89 ±7.03 years and 45% with co-morbidities. Spirometry done for all studied cases included FEV1/FVC, FEV1 and FVC parameters with mean range 43.40 ± 5.17, 38.90 ± 8.60, 79.45 ± 16.59 respectively. The descriptive data of HRCT showed 60% of the patients with emphysema while the rest showed mixed emphysema and ILD. V/Q scan study was positive in 4 patients which represented 20% of the patients whose all included in group B (mPA > 43.5 mmHg). All studied COPD patients who showed severe PHT by a measurement of mPAP > 35 mmHg by RHC with normal PCW pressure underwent cMRI study to assess right ventricular structure and morphology. Conclusion: Cardiac MRI showed a great rule in the evaluation of the morphological changes associated with the condition of COPDPH in the right side of the heart which should affect its functions. The cardiac MRI is not the best tool in assessment of the right side of the heart in COPD patients due to many causes like the difficulty of holding breaths with COPDPH patients during the maneuver to snap accurate clear shots of the heart, the hypoxia in those patients which makes the maneuver more difficult, the associated comorbidities may interfere with completing the maneuver like the chronic kidney disease that prohibit the use of gadolinium dye and other co-morbidities like morbid obesity that will not allow the patient to get through the MRI

Keywords

pulmonary hypertension, chronic obstructive pulmonary disease, right sided heart catheterization, cardiacMRI, echocardiography

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