الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 201 |  |  |
| | | from | 201 | | |
Abstract
Pulmonary hypertension is a pathophysiological complex condition. Hemodynamic definition of pulmonary hypertension depends on assessment of the mean pulmonary pressure. Further classification of pulmonary hypertension patients depend on measurement of pulmonary artery occluding pressure and trans-pulmonary gradient. Furthermore, Cardiac output and pulmonary vascular resistance determine morbidity and mortality of the disease.
Till nowadays, right heart catheter provide such information necessary for diagnosis, classification and risk stratification of the patients. However, right heart catheterization is an invasive that carries serious complications (Hoeper et al., 2006). Cardiac Magnetic Resonance is a non-invasive tool that can give vast information about the morphology and the function of the heart. In addition, cardiac magnetic resonance can accurately assess the pulmonary circulation.
Recently, the role of cardiac magnetic resonance expanded from just evaluation of pericardial effusion and right atrial area for risk assessment to more detailed measurements. However, the diagnostic ability of the Cardiac magnetic resonance imaging is still under investigation.
This study was conducted to assess the use of cardiac magnetic resonance to diagnose pulmonary hypertension in light of the advance in the techniques and the previous studies targeting this issue.
Twenty nine pulmonary hypertension patients underwent right heart catheterization and cardiac magnetic resonance imaging within 1 month provided that patients are clinically stable in that period without any deterioration in their condition.
The study population demographic data and clinical characteristics were plotted. Female gender predominance was observed (24 females and 5 males). group 1 pulmonary hypertension was the most common among the 5 groups. In group 1, idiopathic pulmonary arterial hypertension was the most common.
In cardiac magnetic resonance imaging, atrial volumes as well as right ventricle metrics were measured including: mass, ejection fraction, end systolic and end diastolic volumes and stroke volume. The same metrics for the left ventricle were plotted. All the data were indexed to body surface area of each patient. Septal angle and cardiac output were also measured. The pulmonary circulation was assessed by means of; main pulmonary artery diameter, systolic and diastolic areas and mean velocity.
In the right heart catheterization, systolic, diastolic and mean pressures were measured for the right atrium, right ventricle and the pulmonary artery. Then the pulmonary artery wedge pressure was measured. Cardiac output was calculated using Fick’s method and pulmonary vascular resistance was calculated.
The cardiac magnetic resonance imaging variables were correlated with mean pulmonary artery Pressure, pulmonary artery wedge pressure and pulmonary vascular resistance to determine the most favourable factors to affect their values.
Previous magnetic resonance based mathematical models were used to derive mean pulmonary artery Pressure, pulmonary artery wedge pressure and pulmonary vascular resistance were used. The derived values and estimated values were statistically analysed to find the correlation and agreement with each other.
The results showed mPAP had significant positive correlations with RV mass, RV mass index, VMI, septal angle and PA systolic and diastolic areas. While, negative correlations were found between the measured mPAP with RVEF, RVSV, MPA diameter and PA mean velocity.
On the other hand PVR, PVR had significant positive correlations with Septal angle and VMI but negative correlations with LA volume, LA volume index, RVEF, RVEDV, RSV, LVEDV, LVEDVI, LVESV, LVESVI, LVSV, LVSVI, MPA diameter and PA mean velocity.
Good correlation and agreement was plotted between the derived mean pulmonary artery Pressure and pulmonary vascular resistance. However, derived pulmonary artery wedge pressure didn’t correlate with the invasively estimated pressure but had a good overall agreement.