Diagnostic and prognostic value of cardiac magnetic resonance in patients with pulmonary hypertension

Sammanfattning: Pulmonary arterial hypertension (PAH) is a rare disease with poor prognosis. The symptoms are often unspecific, which can lead to delayed diagnosis. Cardiac magnetic resonance imaging (CMR) can be used to accurately assess the right ventricle (RV) and is the gold standard for measuring volumes and global ventricular function, such as ejection fraction. However, even with preserved ejection fraction subtle changes in cardiac function has been shown in patients with PAH.Therefore, the aims for this thesis were to a) evaluate novel methods using CMR for early risk assessment of PAH, b) if these CMR measures are related to invasive measurements, and c) if CMR can assist improved prognostication.The results of the publication where:I. Lower biventricular longitudinal strain is mainly determined by increased pulmonary pressure and not by systemic sclerosis (SSc) per se. Low longitudinal strain are indicative of increased pulmonary arterial pressure and resistance. II. Left ventricular (LV) longitudinal strain differed in SSc patients with insertion fibrosis or infarction compared to no fibrosis. SSc patients had lower RV longitudinal strain and strain rate compared to controls.III. There was moderate to strong correlation of regional CMR measurements to corresponding echocardiographic measures such as RV lateral atrio-ventricular plane displacement (AVPD), maximum emptying velocity, RV fractional area change and RV free wall strain.IV. Lower LV and RV AVPD were associated with increased risk for lung transplantation or mortality in patients with PAH.V. Dyssynchrony measured as the standard deviation between time to peak strain and pulmonary valve closure from the six walls in three views (short axis, 4 chamber and RV 3 chamber) was associated with decreased transplantation free survival.