scholarly journals Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension

2015 ◽  
Vol 308 (12) ◽  
pp. H1603-H1611 ◽  
Author(s):  
Michael A. Quail ◽  
Daniel S. Knight ◽  
Jennifer A. Steeden ◽  
Liesbeth Taelman ◽  
Shahin Moledina ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Left Pulmonary Artery ◽  
Wave Intensity ◽  
Healthy Controls ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Pulmonary Vessel ◽  
Golden Angle ◽  
Angiographic Data

Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls ( P = 6e−8). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63–100%] and specificity of 91% (95% CI 75–98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.

Abstract 16131: Novel Magnetic Resonance Wave Intensity Analysis in Pulmonary Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael A Quail ◽  
Daniel S Knight ◽  
Jennifer A Steeden ◽  
Liesbeth Taelman ◽  
Shahin Moledina ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arteries ◽  
Wave Intensity ◽  
Healthy Controls ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Resonance Wave ◽  
Golden Angle ◽  
Significant Difference ◽  
Pressure And Velocity Measurements

Background: Pathological pulmonary wave reflections (WR) are a potential hemodynamic biomarker for pulmonary hypertension (PH). WR can be quantified using wave intensity analysis (WIA), typically utilizing simultaneous invasive pressure and velocity measurements. In this study we reformulated WIA to use CMR area and flow to measure reflections non-invasively. We hypothesized that this method could detect differences in WR in PH patients compared to healthy controls and could also differentiate certain PH subtypes. Methods: 20 patients with PH (35% CTEPH), mean age 54years (75% female) and 10 healthy controls, 47years (60% female) were recruited. Branch pulmonary artery (PA) flow volume (Q) and area curves (A) were used to measure wave intensity ( dI ), defined as, dI =[[Unable to Display Character: &#8710;]]Ax[[Unable to Display Character: &#8710;]]Q and dI ± =± c /4 [[[Unable to Display Character: &#8710;]]A± [[Unable to Display Character: &#8710;]]Q/ c ] 2 , where c =wave-speed. Data were acquired using a retrospectively gated, respiratory navigated, golden-angle, 10.5ms temporal resolution, phase-contrast MR sequence. All patients also underwent right heart cardiac catheterization for pressure and vascular resistance (PVR) measurement, median interval 6 days (IQR 2-11days). The presence of proximal clot in CTEPH patients was determined from contemporaneous CT/angiographic data. Results: A backwards-travelling compression wave (BCW) was present in both left and right PAs of all PH patients, but was absent in all controls ( p =6e -8 ). A backwards-travelling expansion/suction wave was present in the 19/20 branch PAs of controls, and only 4/40 PAs in patients ( p < 0.0001). The area under the BCW was associated with a sensitivity of 100% (95% CI 63-100%) and specificity of 91% (95% CI 75-98%) for the presence of clot in the proximal pulmonary arteries of patients with CTEPH. Conclusions: Noninvasive pulmonary WIA accurately delineates pulmonary vascular health and disease. The main findings of this study were: i) There was a significant difference in WIA metrics between patients and controls, in particular, the presence of a BCW was specifically associated with the presence of PH; and ii) The magnitude of the BCW area showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the non-invasive assessment of PH.

scholarly journals Novel magnetic resonance wave intensity analysis in pulmonary hypertension

2014 ◽  
Vol 16 (S1) ◽  
Author(s):  
Michael A Quail ◽  
Daniel S Knight ◽  
Jennifer A Steeden ◽  
Andrew Taylor ◽  
Vivek Muthurangu
Keyword(s):  
Pulmonary Hypertension ◽  
Magnetic Resonance ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Resonance Wave

scholarly journals A review of wave mechanics in the pulmonary artery with an emphasis on wave intensity analysis

2016 ◽  
Vol 218 (4) ◽  
pp. 239-249 ◽  
Author(s):  
J. Su ◽  
O. Hilberg ◽  
L. Howard ◽  
U. Simonsen ◽  
A. D. Hughes
Keyword(s):  
Pulmonary Artery ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Wave Mechanics

Simultaneous pulmonary trunk and pulmonary arterial wave intensity analysis in fetal lambs: evidence for cyclical, midsystolic pulmonary vasoconstriction

2008 ◽  
Vol 294 (5) ◽  
pp. R1554-R1562 ◽  
Author(s):  
Joseph J. Smolich ◽  
Jonathan P. Mynard ◽  
Daniel J. Penny
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Compression Wave ◽  
Main Pulmonary Artery ◽  
Pulmonary Trunk ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Pulmonary Vasoconstriction ◽  
Pulmonary Arterial

The physiological basis of a characteristically low blood flow to the fetal lungs is incompletely understood. To determine the potential role of pulmonary vascular interaction in this phenomenon, simultaneous wave intensity analysis (WIA) was performed in the pulmonary trunk (PT) and left pulmonary artery (LPA) of 10 anesthetized late-gestation fetal sheep instrumented with PT and LPA micromanometer catheters to measure pressure (P) and transit-time flow probes to obtain blood velocity ( U). Studies were performed at rest and during brief complete occlusion of the ductus arteriosus to augment pulmonary vasoconstriction ( n = 4) or main pulmonary artery to abolish wave transmission from the lungs ( n = 3). Wave intensity (d IW) was calculated as the product of the P and U rates of change. Forward and backward components of d IW were determined after calculation of wave speed. PT and LPA WIA displayed an early systolic forward compression wave (FCWis) increasing P and U, and a late systolic forward expansion wave decreasing P and U. However, a marked midsystolic fall in LPA U to near-zero was related to an extremely prominent midsystolic backward compression wave (BCWms) that arose ∼5 cm distal to the LPA, was threefold larger than the PT BCWms ( P < 0.001), of similar size to FCWis at rest ( P > 0.6), larger than FCWis following ductal occlusion ( P < 0.05) and abolished after main pulmonary artery occlusion. These findings suggest that the absence of pulmonary arterial midsystolic forward flow which accompanies a low fetal lung blood flow is due to a BCWms generated in part by cyclical vasoconstriction within the pulmonary microcirculation.

4.6 WAVE INTENSITY ANALYSIS IN THE PULMONARY ARTERY

2014 ◽  
Vol 8 (4) ◽  
pp. 127 ◽  
Author(s):  
J. Su ◽  
C. Manisty ◽  
K. Parker ◽  
A. Hughes
Keyword(s):  
Pulmonary Artery ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

2004 ◽  
Vol 286 (1) ◽  
pp. H267-H275 ◽  
Author(s):  
Ellen H. Hollander ◽  
Gary M. Dobson ◽  
Jiun-Jr Wang ◽  
Kim H. Parker ◽  
John V. Tyberg
Keyword(s):  
Pulmonary Artery ◽  
Left Ventricular ◽  
Wave Intensity ◽  
Pulmonary Vasculature ◽  
Pressure Waves ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Compression Waves ◽  
In Series ◽  
Late Systole

Pressure waves are thought to travel from the left atrium (LA) to the pulmonary artery (PA) only retrogradely, via the vasculature. In seven anesthetized open-chest dogs, a balloon was placed in the LA, which was rapidly inflated and deflated during diastole, early systole, and late systole. High-fidelity pressures were measured within and around the heart. Measurements were made at low volume [LoV; left ventricular end-diastolic pressure (LVEDP) = 5–9 mmHg], high volume (HiV; LVEDP = 16–19 mmHg), and HiV with the pericardium removed. Wave-intensity analysis demonstrated that, except during late systole, balloon inflation created forward-going PA compression waves that were transmitted directly through the heart without measurable delay; backward PA compression waves were transmitted in-series through the pulmonary vasculature and arrived after delays of 90 ± 3 ms (HiV) and 103 ± 5 ms (LoV; P < 0.05). Direct transmission was greater during diastole, and both direct and series transmission increased with volume loading. Pressure waves from the LA arrive in the PA by two distinct routes: rapidly and directly through the heart and delayed and in-series through the pulmonary vasculature.

Pulmonary artery wave intensity analysis following lung resection

2017 ◽  
Vol 31 ◽  
pp. S5-S6
Author(s):  
Adam Glass ◽  
P McCall ◽  
A Arthur ◽  
J Kinsella ◽  
B Shelley
Keyword(s):  
Pulmonary Artery ◽  
Lung Resection ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis

3.4 WAVE INTENSITY ANALYSIS PROVIDES NOVEL INSIGHTS INTO PULMONARY HYPERTENSION

2016 ◽  
Vol 16 (C) ◽  
pp. 51
Author(s):  
Junjing Su ◽  
Charlotte Manisty ◽  
Kim H. Parker ◽  
Soren Mellemkjaer ◽  
Luke Howard ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis
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