Table 2

Advantages and disadvantages of CMR measurements in pulmonary hypertension

VariableMain advantagesMain disadvantages
RV and LV: EDVI/ESVI/SVI, myocardial massRoutinely performed, reliable assessment of cardiac size, RVEDVI/LVEDVI/SVI and RV mass index predictors of mortality in adult PH, initial and follow-up study to study disease progressionObserver variance problems depending on standards/training
EFRoutinely assessed parameter of global ventricular pump function, RVEF related to outcome in paediatric PHLoad-dependent parameter of RV function, may miss early systolic dysfunction
Blood flow (PCMR)Routinely performed, selective blood flow measurements in any vessel of appropriate size possible, estimation of pulmonary and systemic blood flow, quantification of shunt flow, low intrastudy and interstudy reproducibilityTime consuming if several vessels are examined, helical flow pattern in main PA, no accurate assessment of peak blood flow velocities (no reliable assessment of pressure gradients), susceptible to non-flow-related phase errors
Late gadolinium enhancement (LGE)Visualisation of macroscopic myocardial fibrosisContrast agent necessary, longer examination time, conflicting data regarding prognostic value of LGE in adults, no data in paediatric PH
Strain, strain rateAdditional parameter of myocardial function, assessment of intraventricular and interventricular dyssynchrony, postprocessing analysis by tissue tracking software, easy to performNot routinely assessed, tagging techniques time consuming, myocardial feature tracking from cine-SSFP possible but no data available in paediatric PH for either technique
Septal curvatureValid estimation of sPAP and PVR in paediatric PHNot routinely assessed, postprocessing time
T1 mappingQuantification of diffuse myocardial fibrosisOnly data in experimental model of chronic PH
Pulmonary artery stiffness: pulsatility/capacitance/distensibility/complianceEarly marker of PH; independently associated with the degree of RV dysfunction, dilation, and hypertrophy in PHNot routinely assessed, no data in paediatric PH
RV–PA couplingEasy to calculate, comprehensive analysis of ventricular contractility and vascular load, correlated with outcome in adult PHInvasive data necessary, no data in paediatric PH
  • CMR, cardiac MR; EDVI, indexed enddiastolic volume; ESVI, indexed endsystolic volume; LGE, late gadolinium enhancement; LV, left ventricle; LVEDVI, indexed left ventricular enddiastolic volume; PH, pulmonary hypertension; PCMR, phase-contrast MR; PVR, pulmonary vascular resistance; RV, right ventricular; RVEDVI, indexed right ventricular enddiastolic volume; RVEF, right ventricular ejection fraction; SSFP, steady-state free precession.