Towards a more comprehensive assessment of pulmonary vascular phenotypes by magnetic resonance-augmented right heart catheterisation

Patients with pulmonary hypertension (PH) continue to have high mortality even with the availability of advanced therapies for PH.

Despite a common haemodynamic definition for all causes of treatable (group 1 and group 4) pre-capillary PH, there is considerable variability in patient outcome and treatment response within these subgroups.

This may be accounted for by the phenotypic complexity of PH, for which better biomarkers of disease are required to discriminate between vascular phenotypes.

In order to routinely obtain these biomarkers in large cohorts of PH patients, a clinically applicable and inexpensive approach is required.

Cardiovascular magnetic resonance-guided right heart catheterisation (CMR-RHC) is a standard clinical procedure at our institution that could provide a solution to this problem.

Biomarkers obtained by CMR-RHC can be used to evaluate pulsatile components of afterload, such as pulmonary arterial compliance, pulmonary vascular impedance and wave intensity analysis.

The aims of this study are to understand the importance of vascular phenotype (defined by these biomarkers) in different types of PH, its relationship with RV remodelling and its utility in predicting outcome.

I believe that a more comprehensive assessment of vascular phenotype in PH will lead to a better understanding of this disease and improved patient outcomes.