Abstract #2477

MRI 4D-flow virtual Work-Energy analysis of pulmonary arterial vortical flow and pressure reversal in pulmonary hypertension

Raheeq Karim¹, Alexander Fyrdahl^2,3, Joao G Ramos¹, Michael Melin⁴, Patrik Sundblad^2,5, David Marlevi*^2,6, and Björn Wieslander*¹

¹Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden, ²Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden, ³Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, ⁴Department of Medicine, Unit of Cardiology, Heart and Vascular Theme, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden, ⁵Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden, ⁶Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Boston, MA, United States

Synopsis

Keywords: Velocity/Flow, Lung, Pulmonary Hypertension; Right heart catheterization (RHC); Virtual Work Energy Relative Pressure (vWERP)

Motivation: Pathological main pulmonary artery (MPA) vortex duration (T_vortex) assessed by 4D-flow MRI can potentially diagnose pulmonary hypertension (PH) non-invasively. Early systolic pressure reversal has been hypothesized but not proven to cause MPA vortical flow.

Goal(s): To test whether T_vortex correlates with time to systolic pressure reversal (T_rev) in the MPA.

Approach: Thirty-six patients who had undergone right heart catheterization and MRI were analyzed retrospectively using virtual work energy relative pressure (vWERP) to measure T_rev in the MPA.

Results: T_vortex correlated significantly but weakly with T_rev, indicating that early pressure reversal is not the sole mechanism behind MPA vortices in PH.

Impact: Our results contribute to elucidating the mechanistic link between pulmonary hypertension and vortical blood flow in the pulmonary artery, which may in turn inform the appropriate clinical role of 4D-flow MRI in pulmonary hypertension.

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