Proximal Pulmonary Arterial Helicity Is A Marker Of Hemodynamics And Rv Performance In Pulmonary Arterial Hypertension

  • Schafer M
  • Fenster B
  • Hertzberg J
 et al. 
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Background: Blood flow topologies in the proximal pulmonary vasculature demonstrate helical formations whose functional significance remains unexplored in pulmonary arterial hypertension (PAH). Four-dimensional cardiac magnetic resonance (4D CMR) can generate high-fidelity spatial and temporal renderings of these complex flow patterns and allow for quantitative characterization. Helicity, the novel hemodynamic index measuring the streamwise component of vortex lines in blood flow, may serve to quantitate these helical formations and provide novel insights into pulmonary vasculature fluid-tissue interactions. We tested the relationship between 4D CMR-computed helicity and invasive hemodynamic parameters obtained from same-day right heart catheterization (RHC). Methods: As part of prospective study, 16 PAH patients and 5 age-matched controls underwent same-day 4D-CMR and RHC. Main and right pulmonary arterial (MPA and RPA) peak systolic helicities were calculated using Paraview (Kitware, Clifton, NY). Helicity was correlated with pulmonary hemodynamics (mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and pulmonary arterial wedge pressure (PAWP); indices of right ventricular (RV) performance (thermodilution cardiac output (CO), ejection fraction (RVEF)); RV morphology (end-systolic volume (RVESV), diastolic volume (RVEDV)); and ventricular-vascular coupling (Ea/Emax). Statistical analysis was performed using a paired 2-tailed Student's T-test for intergroup variability and Spearman's Rho for multivariate analysis (JMP v10.0, Cary, NC). Results: There was trend towards significantly decreased RPA helicity in PAH patients vs. controls (0.65 m.s-2 vs. 1.85 m.s-2, p=0.06). However, there was no significant difference between PAH and controls in MPA helicity (1.96 m.s-2 vs. 1.91 vs., p=0.79). MPA helicity showed significant positive correlations with RVEF (rho 0.71, p=0.007) and RVCO (rho 0.55, p=0.008) and significant negative correlations with RVEDV (rho -0.49, p = 0.033) and RVESV (rho -0.71, p

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  • M Schafer

  • B E Fenster

  • J Hertzberg

  • J Buckner

  • K Hunter

  • V O Kheyfets

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