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Cardiac Magnetic Resonance Imaging

Recent advances in the understanding of the pathogenesis of PAH have been translated into effective therapies tested in clinical trials. There are 3 classes of medications that have shown efficacy in the treatment of PAH; prostacyclin analogues, endothelin receptor antagonists and phosphodiesterase-5 inhibitors. These drugs are expensive and potentially dangerous therapies. Assessment of the patient?s response to intervention is imperative at an early stage. Our ability to monitor treatment response is limited by the investigations currently available. Physicians currently rely on echocardiography, right heart catheterisation and 6 minute walk test. These investigations have acknowledged limitations. Expert opinion has reinforced the importance of finding alternative means of assessment in PAH, including both diagnostic and monitoring tools which can be used as end-points in therapeutic trials.

 

Cardiac Magnetic Resonance (CMR) imaging is an attractive modality for studying the complex geometry of the right ventricle and pulmonary vasculature. It is widely recognised as an accurate and reproducible means of measuring RV volume, RV mass, and pulmonary arterial flow in patients with PAH. Variables measured at MRI accurately predict mean pulmonary artery pressure at right heart catheterisation and may provide a more accurate assessment of disease progression or treatment response in PAH.

 

CMR imaging is non-invasive in nature, easy to tolerate and does not expose the patient to any radiation risk.

 

Dr.McLure is using CMR imaging to assess disease progression and the response to disease targeted therapy. The aim is to validate a non-invasive, accurate means by which patients with PAH can be monitored. CMR scans are performed at baseline (prior to institution of therapy) and at scheduled time intervals thereafter. All patients referred to the SPVU for investigation of suspected PAH are invited to have CMR imaging. Patient selection depends upon compliance with MRI safety criteria, ability to lie flat and breath holding ability. We are involved in the coordination of a pan European study (EURO MR) to accumulate as much MR longitudinal data as possible in PAH patients. CMR data is sent to the SPVU from other European PAH Centres for analysis. The CMR results will be compared with findings at RHC, 6MWT distance, serum NTproBNP measurements and WHO functional class. To enable the monitoring of therapy efficacy, it is desirable to measure the signs of PAH non-invasively. It is proposed that CMR imaging will fulfil this role and facilitate an advance in the continuing care of patients with PAH.

 

In addition, we are interested in the influence of genomics upon the adaptation of the right ventricle and pulmonary circulation to treatment of PAH. Specifically we plan to assess for mutations of BMPR2 gene and polymorphisms of the 5-HT transporter, endothelial NOS and ACE genes. The results of genetic testing will be correlated with the response to disease targeted treatment, as measured by; CMR, invasive pulmonary haemodynamics, 6 minute walk test distance and NTproBNP.

 

Epidemiology

Since the SPVU receives referral for all patients in Scotland, the collective data provides a valuable perspective on the epidemiology of pulmonary hypertension within a single country and the Unit has an active programme to define and document this.

 

Pulmonary Haemodynamics

The SPVU has explored the potential for ambulatory pulmonary artery pressure monitoring using solid state manometer tipped pressure transducers. Currently we are exploring the possibility of non-invasive cardiac output measurement during exercise.

 

Staff

  • Professor Andrew Peacock
  • Dr Martin Johnson
  • Dr Nicola Lee
  • Dr Stephen Crawley

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SCOTTISH PULMONARY VASCULAR UNIT - All rights reserved - Clydebank, Scotland - 0141 951 5497 - SPVUnit@gjnh.scot.nhs.uk