State-of-the-Art Paper
Role of Cardiac Magnetic Resonance Imaging in the Management of Patients With Pulmonary Arterial Hypertension

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Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation that results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance. Recent advances in magnetic resonance imaging (MRI) technology have led to the development of techniques for noninvasive assessment of cardiovascular structure and function, including hemodynamic parameters in the pulmonary circulation, which are superior in their identification of right ventricular morphologic changes. These advantages make cardiac MRI an attractive modality for following up and providing prognoses in patients with PAH. In this review, we summarize recent developments in the use of MRI for the diagnosis, assessment, and ongoing monitoring of patients with PAH. Over the coming decade, it can be anticipated that continued improvements in MRI image acquisition, spatial and temporal resolution, and analytical techniques will result in improved understanding of PAH pathophysiology, diagnosis, and prognostic variables, and will supplement, and may even replace, some of the invasive procedures currently applied routinely to the evaluation of PAH.

Key Words

echocardiography
magnetic resonance imaging
pulmonary heart disease
remodeling

Abbreviations and Acronyms

cMRI
cardiac magnetic resonance imaging
CTEPH
chronic thromboembolic pulmonary arterial hypertension
DCE
delayed contrast enhancement
IPAH
idiopathic pulmonary arterial hypertension
LV
left ventricle/ventricular
mPAP
mean pulmonary artery pressure
MRI
magnetic resonance imaging
PA
pulmonary artery/arterial
PAH
pulmonary arterial hypertension
PVR
pulmonary vascular resistance
RHC
right heart catheterization
RV
right ventricular/ventricle
sPAP
systolic pulmonary artery pressure
VMI
ventricular mass index

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Supported by a grant from Actelion Pharmaceuticals. Dr. Benza received honoraria from Actelion, Encysive, and Pfizer.