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Characterization of pulmonary arterial stiffness using cardiac MRI

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Abstract

Pulmonary arterial stiffness (PAS) is a pathologic hallmark of all types of pulmonary hypertension (PH). Cardiac MRI (CMR), a gold-standard imaging modality for the evaluation of pulmonary flow, biventricular morphology and function has been historically reserved for the longitudinal clinical follow-up, PH phenotyping purposes, right ventricular evaluation, and research purposes. Over the last two decades, numerous indices combining invasive catheterization and non-invasive CMR have been utilized to phenotype the character and severity of PAS in different types of PH and to assess its clinically prognostic potential with encouraging results. Many recent studies have demonstrated a strong role of CMR derived PAS markers in predicting long-term clinical outcomes and improving currently gold standard risk assessment provided by the REVEAL calculator. With the utilization of a machine learning strategies, strong diagnostic and prognostic performance of CMR reported in multicenter studies, and ability to detect PH at early stages, the non-invasive assessment of PAS is on verge of routine clinical utilization. In this review, we focus on appraising important CMR studies interrogating PAS over the last 20 years, describing the benefits and limitations of different PAS indices, and their pathophysiologic relevance to pulmonary vascular remodeling. We also discuss the role of CMR and PAS in clinical surveillance and phenotyping of PH, and the long-term future goal to utilize PAS as a biomarker to aid with more targeted therapeutic management.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado – Denver | Anschutz Medical Campus, Aurora, CO, USA

    Michael T. Cain, Michal Schäfer, Sarah Park & Jordan R.H. Hoffman

  2. Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA

    Kurt R. Stenmark & Yen-Rei A. Yu

  3. Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA

    Alex J. Barker & Daniel Vargas

  4. Department of Critical Care and Pulmonary Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA

    Todd M. Bull

  5. Heart Institute, Children’s Hospital Colorado, University of Colorado, Denver, USA

    Michal Schäfer & D. Dunbar Ivy

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M.T.C, M.S., J.R.H, A.J.B, D.D.I., Y.A.Y, K.S., T.B., D.V. and S.P. all contributed to separate sections of the review text. M.T.C., M.S., and J.R.H. developed figures. All authors reviewed the manuscript.

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Correspondence to Michal Schäfer.

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Cain, M.T., Schäfer, M., Park, S. et al. Characterization of pulmonary arterial stiffness using cardiac MRI. Int J Cardiovasc Imaging 40, 425–439 (2024). https://doi.org/10.1007/s10554-023-02989-6

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