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
Helmholtz Center Munich, Haunersches Children’s Hospital. Leiden University. University Children’s Hospital, University Hospital and Ludwig-Maximilian University. Hospital for Sick Children. Justus-Liebig-University Giessen.
Germany, Netherlands and Canada
European Respiratory Journal
Eur Respir J 2023;
DOI: 10.1183/13993003.02445-2022
Abstract
Rationale: 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.
Objectives: 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 3TMRI in spontaneous sleep near term (AIRR study). Semi-manual PA flow quantification (phase-contrast MRI, no BPD n=28, mild n=35, moderate/severe n=25) was complemented by cardiac function assessment (cine MRI).
Measurements and main results: We identified abnormalities in PA flow and cardiac function, i.e. increased net forward volume (ratio right-over-left), decreased mean relative area change and pathologic right end-diastolic volume to sensitively detect BPD-associated PVD while correcting for PMA (L1OAUC=0.88/sensitivity=0.80/specificity=0.81). We linked these changes to increased right ventricular (RV) afterload (RV-arterial coupling (p=0.02), PA midsystolic notching (p=0.015(t2)), 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 (R=0.62, p=3.7×10-4) and oxygen supplementation (R=0.58, p=9.2×10-4).
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.
Category
Class III. Pulmonary Hypertension Associated with Lung Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes