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This study aimed to evaluate the potential of MR 4-dimensional (4D) flow imaging to predict changes in the mean pulmonary arterial pressure (mPAP) during serial investigations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Forty-four adult patients with PH or at risk of developing PH repeatedly underwent routine right heart catheterization (RHC) and near-term MR 4D flow imaging of the main pulmonary artery. The duration of vortical blood flow along the main pulmonary artery was evaluated from MR 4D velocity fields using prototype software and converted to an MR 4D flow imaging-based mPAP estimate (mPAP<jats:sub>MR<\/jats:sub>) by a previously established model. The relationship of differences between RHC-derived baseline and follow-up mPAP values (\u0394mPAP) to corresponding differences in mPAP<jats:sub>MR<\/jats:sub> (\u0394mPAP<jats:sub>MR<\/jats:sub>) was analyzed by means of regression and Bland-Altman analysis; the diagnostic performance of \u0394mPAP<jats:sub>MR<\/jats:sub> in predicting mPAP increases or decreases was investigated by ROC analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Areas under the curve for the prediction of mPAP increases and decreases were 0.92 and 0.93, respectively. With the natural cutoff \u0394mPAP<jats:sub>MR<\/jats:sub> = 0 mmHg, mPAP increases (decreases) were predicted with an accuracy, sensitivity, and specificity of 91% (91%), 85% (89%), and 94% (92%), respectively. For patients in whom 4D flow allowed a point estimate of mPAP (mPAP &gt; 16 mmHg), \u0394mPAP<jats:sub>MR<\/jats:sub> correlated strongly with \u0394mPAP (<jats:italic>r<\/jats:italic> = 0.91) and estimated \u0394mPAP bias-free with a standard deviation of 5.1 mmHg.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>MR 4D flow imaging allows accurate non-invasive prediction and quantification of mPAP changes in adult patients with PH or at risk of developing PH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link> identifier: NCT00575692 and NCT01725763<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 MR 4D flow imaging allows accurate non-invasive prediction of mean pulmonary arterial pressure increases and decreases in adult patients with or at risk of developing pulmonary hypertension.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 In adult patients with mean pulmonary arterial pressure &gt; 16 mmHg, MR 4D flow imaging allows estimation of longitudinal mean pulmonary arterial pressure changes without bias with a standard deviation of 5.1 mmHg.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-020-07287-6","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T18:04:08Z","timestamp":1600970648000},"page":"1883-1893","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["MR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-2528","authenticated-orcid":false,"given":"Ursula","family":"Reiter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Kovacs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina","family":"Kr\u00e4uter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volha","family":"Nizhnikava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fuchsj\u00e4ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Olschewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,24]]},"reference":[{"key":"7287_CR1","doi-asserted-by":"publisher","first-page":"1801913","DOI":"10.1183\/13993003.01913-2018","volume":"53","author":"G Simonneau","year":"2019","unstructured":"Simonneau G, Montani D, Celermajer DS et al (2019) Haemodynamic definitions and updated clinical classification of pulmonary hypertension. 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The study was performed under a Master Research Agreement between the Medical University of Graz, Graz University of Technology, and Siemens Healthcare Diagnostics GmbH.The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors (Gert Reiter) has significant statistical expertise. No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all patients in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.Ethical committee: Medical University of Graz, Austria.: NCT00575692 and NCT01725763","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Study patients were participants in two prospective studies enrolling consecutive patients with PH or with a risk of having PH and referring them for comprehensive cardiac MR imaging at 1.5 T and 3 T after RHC. Multiple studies have been published from these cohorts (Ref. , \u2013). This is the first study including 4D flow data from 3 T (NCT01725763), as well as follow-up 4D flow data at 1.5 T (NCT00575692).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 retrospective analysis of two prospective studies\u2022 diagnostic or prognostic study\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}