In European heart journal. Cardiovascular Imaging
AIMS : Pulmonary transit time (PTT) is the time blood takes to pass from the right ventricle to the left ventricle via pulmonary circulation. We aimed to quantify PTT in routine cardiovascular magnetic resonance imaging perfusion sequences. PTT may help in the diagnostic assessment and characterization of patients with unclear dyspnoea or heart failure (HF).
METHODS AND RESULTS : We evaluated routine stress perfusion cardiovascular magnetic resonance scans in 352 patients, including an assessment of PTT. Eighty-six of these patients also had simultaneous quantification of N-terminal pro-brain natriuretic peptide (NTproBNP). NT-proBNP is an established blood biomarker for quantifying ventricular filling pressure in patients with presumed HF. Manually assessed PTT demonstrated low inter-rater variability with a correlation between raters >0.98. PTT was obtained automatically and correctly in 266 patients using artificial intelligence. The median PTT of 182 patients with both left and right ventricular ejection fraction >50% amounted to 6.8 s (Pulmonary transit time: 5.9-7.9 s). PTT was significantly higher in patients with reduced left ventricular ejection fraction (<40%; P < 0.001) and right ventricular ejection fraction (<40%; P < 0.0001). The area under the receiver operating characteristics curve (AUC) of PTT for exclusion of HF (NT-proBNP <125 ng/L) was 0.73 (P < 0.001) with a specificity of 77% and sensitivity of 70%. The AUC of PTT for the inclusion of HF (NT-proBNP >600 ng/L) was 0.70 (P < 0.001) with a specificity of 78% and sensitivity of 61%.
CONCLUSION : PTT as an easily, even automatically obtainable and robust non-invasive biomarker of haemodynamics might help in the evaluation of patients with dyspnoea and HF.
Segeroth Martin, Winkel David Jean, Strebel Ivo, Yang Shan, van der Stouwe Jan Gerrit, Formambuh Jude, Badertscher Patrick, Cyriac Joshy, Wasserthal Jakob, Caobelli Federico, Madaffari Antonio, Lopez-Ayala Pedro, Zellweger Michael, Sauter Alexander, Mueller Christian, Bremerich Jens, Haaf Philip
2023-Jan-20
N-terminal pro-brain natriuretic peptide, artificial intelligence, cardiovascular magnetic resonance imaging, haemodynamic biomarker, heart failure, pulmonary transit time
