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MRI pulmonary artery flow detects lung vascular pathology in preterms with lung disease
PDPI Malang, 06 Feb 2024 07:46:00

Friederike Häfner, Alida Kindt, Kathrin Strobl, Kai Förster, Motaharehsadat Heydarian, Erika Gonzalez, Benjamin Schubert, Yvonne Kraus, Robert Dalla Pozza, Andreas W. Flemmer, Birgit Ertl-Wagner, Olaf Dietrich, Sophia Stoecklein, Khodr Tello, Anne Hilgendorff
European Respiratory Journal 2023 62: 2202445; DOI: 10.1183/13993003.02445-2022

Abstract

Background Pulmonary vascular disease (PVD) affects the majority of preterm neonates with bronchopulmonary dysplasia (BPD) and significantly determines long-term mortality through undetected progression into pulmonary hypertension. Our objectives were to associate characteristics of pulmonary artery (PA) flow and cardiac function with BPD-associated PVD near term using advanced magnetic resonance imaging (MRI) for improved risk stratification.

Methods Preterms <32 weeks postmenstrual age (PMA) with/without BPD were clinically monitored including standard echocardiography and prospectively enrolled for 3 T MRI in spontaneous sleep near term (AIRR (Attention to Infants at Respiratory Risks) study). Semi-manual PA flow quantification (phase-contrast MRI; no BPD n=28, mild BPD n=35 and moderate/severe BPD n=25) was complemented by cardiac function assessment (cine MRI).

Results We identified abnormalities in PA flow and cardiac function, i.e. increased net forward volume right/left ratio, decreased mean relative area change and pathological right end-diastolic volume, to sensitively detect BPD-associated PVD while correcting for PMA (leave-one-out area under the curve 0.88, sensitivity 0.80 and specificity 0.81). We linked these changes to increased right ventricular (RV) afterload (RV–arterial coupling (p=0.02), PA mid-systolic notching (t2; p=0.015) and cardiac index (p=1.67×10−8)) and correlated echocardiographic findings. Identified in moderate/severe BPD, we successfully applied the PA flow model in heterogeneous mild BPD cases, demonstrating strong correlation of PVD probability with indicators of BPD severity, i.e. duration of mechanical ventilation (rs=0.63, p=2.20×10−4) and oxygen supplementation (rs=0.60, p=6.00×10−4).

Conclusions Abnormalities in MRI PA flow and cardiac function exhibit significant, synergistic potential to detect BPD-associated PVD, advancing the possibilities of risk-adapted monitoring.

Juara III - PDPI Cab Malang
Uploaded on March 27, 2022