BACKGROUND Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. METHODS Consecutive clinically referred patients (n = 60, median [interquartile range] age 60 [48-68] years, 33% female) underwent echocardiography and CMR at 1.5 T (n = 43) or 3 T (n = 17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity > 2.8 m/s (TRPG > 31 mmHg). RESULTS Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p < 0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R2 = 0.65, p < 0.001). CONCLUSIONS There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.

中文翻译：

---

心血管磁共振4D流动分析比多普勒超声心动图检查具有更高的诊断率，可检测出肺动脉压升高。

背景技术通过使用右心导管检查法测量平均肺动脉（PA）压力（mPAP）可以明确诊断肺动脉高压。心血管磁共振（CMR）二维（4D）流量分析可以根据PA中的血流涡流持续时间估算mPAP，具有出色的结果。此外，通过多普勒超声心动图测量的收缩期三尖瓣反流（TR）峰值压力梯度（TRPG）通常用于临床常规中以评估收缩期PA压力。这项研究旨在比较CMR和超声心动图在定量和分类一致性以及检测PA压力升高的诊断率方面。方法连续接受临床转诊的患者（n = 60，中位[四分位数范围]年龄60 [48-68]岁，女性33％）接受超声心动图和CMR评分为1。5 T（n = 43）或3 T（n = 17）。PA涡流持续时间用于使用覆盖主PA的市售时间分辨的多个2D切片相位对比三方向速度编码序列估算mPAP。经胸多普勒超声心动图测量TR和得出TRPG。诊断合格率定义为CMR或超声心动图检测到PA压力升高的病例比例，定义为涡旋持续时间≥心动周期的15％（mPAP≥25mmHg）或TR速度> 2.8 m / s（TRPG> 31 mmHg ）。结果CMR和超声心动图均显示39/60（65％）患者的PA压力正常，9/60（15％）患者的PA压力升高，48/60（80％）患者的总体一致性，kappa 0.49（95％置信度）区间0.27-0.71）。与超声心动图相比，CMR具有更高的诊断率，可检测出PA压力升高（21/60（35％）对9/60（15％），p <0.001）。在同时观察到PA涡流和可测量TR速度的情况下（34 / 60，56％），TRPG与mPAP相关（R2 = 0.65，p <0.001）。结论CMR估计的mPAP与超声心动图估计的TRPG之间存在良好的定量和公平分类协议。与超声心动图相比，CMR具有更高的诊断率，可检测出PA压力升高，这可能是由于超声心动图与CMR相比，在检测到PA压力升高时灵敏度较低，这与通过超声心动图充分可视化和测量TR射流的能力受到限制有关。超声心动图之间的未来比较，