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Häfner, F. ; Kindt, A.S.D.* ; Strobl, K.* ; Forster, K.* ; Heydarian, M. ; Gonzalez-Rodriguez, E. ; Schubert, B. ; Kraus, Y.* ; Robert, D.P.* ; Flemmer, A.W.* ; Ertl-Wagner, B.* ; Dietrich, O.* ; Stoecklein, S.* ; Tello, K.* ; Hilgendorff, A.

MRI pulmonary artery flow detects lung vascular pathology in preterms with lung disease.

Eur. Respir. J. 62:14 (2023)
Publ. Version/Full Text DOI PMC
Open Access Gold (Paid Option)
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.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Bronchopulmonary Dysplasia; Clinical-features; Hypertension; Infants; Risk; Children; Outcomes; Echocardiography; Endarterectomy; Mortality
ISSN (print) / ISBN 0903-1936
e-ISSN 1399-3003
Journal European Respiratory Journal
Quellenangaben Volume: 62, Issue: 6, Pages: , Article Number: 14 Supplement: ,
Publisher European Respiratory Society
Publishing Place Sheffield
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Lung Health and Immunity (LHI)
Institute of Computational Biology (ICB)
Grants Lander
LMUexcellent (Free State of Bavaria) under the Excellence Strategy of the Federal Government
LMUexcellent (BMBF)
CRC
Stiftung AtemWeg (LSS AIRR)
Research Training Group "Targets in Toxicology" German Science and Research Organisation (DFG)
German Center for Lung Research (DZL) (BMBF)
Helmholtz Foundation (Federal Ministry of Education and Research in Germany (BMBF))
International Research Group "Role of BMP signalling"
Helmholtz Zentrum Muenchen, Germany
Helmholtz Foundation
Young Investigator Grant