BACKGROUND Cardiovascular magnetic resonance imaging (CMR) is valuable for the investigation and management of pulmonary artery hypertension (PAH), but the direct measurement of pulmonary hemodynamics by right heart catheterization is still necessary. CMR-guided right heart catheterization (CMR-RHC) combines the benefits of CMR and invasive cardiac catheterization, but its feasibility in patients with acquired PAH has not been established. The aims of this study are to: (1) demonstrate the feasibility of CMR-RHC in patients being assessed for PAH in a conventional diagnostic CMR scanner room; (2) determine the predictors of (i) procedure duration, and (ii) procedural failure or technical difficulty as determined by the adjunctive need for a guidewire. METHODS Fifty patients investigated for suspected or known PH underwent CMR-RHC. Durations of separate procedural components were recorded, including time taken to pass the catheter from the femoral vein to a stable wedge position (procedure time) and total time the patient spent in the CMR department (department time). Associations between procedural failure/guidewire usage and hemodynamic/CMR measures were assessed using logistic regression. Relationships between procedure times and hemodynamic/CMR measures were evaluated using Spearman's correlation coefficient. RESULTS A full CMR-RHC study was successfully completed in 47 (94%) patients. CMR-conditional guidewires were used in 6 (12%) patients. Metrics associated with guidewire use/procedural failure were higher mean pulmonary artery (PA) pressures (mPAP: OR = 1.125, p = 0.018), right heart dilatation (right ventricular (RV) end-systolic volume (RVESV): OR = 1.028, p = 0.018), RV hypertrophy (OR = 1.050, p = 0.0067) and RV ejection fraction (EF) (OR = 0.914, p = 0.014). Median catheter and department times were 3.6 (2.0-7.7) minutes and 60.0 (54.0-68.5) minutes, respectively. All procedure times became significantly shorter with increasing procedural experience (p < 0.05). Catheterization time was also associated with PH severity (RV systolic pressure: rho = 0.46, p = 0.0013) and increasing RV end-systolic volume (RVESV: rho = 0.41, p = 0.0043), hypertrophy (rho = 0.43, p = 0.0025) and dysfunction (RVEF: rho = - 0.32, p = 0.031). CONCLUSIONS This study demonstrates that CMR-RHC using standard technology can be incorporated into routine clinical practice for the investigation of PAH. Procedural failure was rare but more likely in patients with severe PAH. Procedure time is clinically acceptable and increases with worsening PAH severity.

中文翻译：

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在传统 CMR 环境中进行心血管磁共振引导的右心导管插入术 - 肺动脉高压手术成功和持续时间的预测因素。


背景心血管磁共振成像（CMR）对于肺动脉高压（PAH）的调查和治疗具有重要价值，但通过右心导管直接测量肺血流动力学仍然是必要的。 CMR 引导的右心导管检查 (CMR-RHC) 结合了 CMR 和侵入性心导管检查的优点，但其在获得性 PAH 患者中的可行性尚未确定。本研究的目的是：(1) 证明 CMR-RHC 在传统诊断 CMR 扫描仪室中评估 PAH 的患者的可行性； (2) 确定 (i) 手术持续时间和 (ii) 手术失败或技术难度的预测因素（由导丝的辅助需求确定）。方法 50 名疑似或已知 PH 患者接受了 CMR-RHC 治疗。记录各个手术组成部分的持续时间，包括将导管从股静脉传递到稳定的楔形位置所需的时间（手术时间）以及患者在 CMR 科室花费的总时间（科室时间）。使用逻辑回归评估手术失败/导丝使用与血流动力学/CMR 测量之间的关联。使用 Spearman 相关系数评估手术时间和血流动力学/CMR 测量值之间的关系。结果 47 名 (94%) 患者成功完成了完整的 CMR-RHC 研究。 6 名 (12%) 患者使用了 CMR 条件导丝。与导丝使用/手术失败相关的指标是较高的平均肺动脉（PA）压力（mPAP：OR = 1.125，p = 0.018），右心扩张（右心室（RV）收缩末期容积（RVESV）：OR = 1.028， p = 0.018）、RV 肥大（OR = 1.050，p = 0.0067）和 RV 射血分数 (EF)（OR = 0.914，p = 0.014）。 中位导管时间和科室时间分别为 3.6 (2.0-7.7) 分钟和 60.0 (54.0-68.5) 分钟。随着手术经验的增加，所有手术时间都显着缩短（p < 0.05）。插管时间还与 PH 严重程度（RV 收缩压：rho = 0.46，p = 0.0013）和 RV 收缩末期容量增加（RVESV：rho = 0.41，p = 0.0043）、肥大（rho = 0.43，p = 0.0025）相关。和功能障碍（RVEF：rho = - 0.32，p = 0.031）。结论 本研究表明，使用标准技术的 CMR-RHC 可以纳入 PAH 调查的常规临床实践中。手术失败的情况很少见，但在严重 PAH 患者中更有可能发生。手术时间在临床上是可以接受的，并且随着 PAH 严重程度的恶化而增加。