4D-Flow MRI-Derived Wall Shear Stress as a Non-Invasive Biomarker for the Detection and Hemodynamic Characterization of Pulmonary Hypertension.
7 affiliations
- 1Medical Research Council, Laboratory of Medical Sciences Imperial College London London UK.
- 2Institute of Clinical Sciences Imperial College London London UK.
- 3National Heart and Lung Institute Imperial College London London UK.
- 4Department of Chemical Engineering Imperial College London London UK.
- 5Department of Cardiology Royal Melbourne Hospital Melbourne Australia.
- 6Siemens Healthineers Erlangen Germany.
- 7National Pulmonary Hypertension Service Imperial College Healthcare NHS Trust London UK.
Abstract
Invasive right heart catheterization (RHC) remains the reference standard for diagnosing pulmonary hypertension (PH), but there is a pressing need for non-invasive techniques to assess pulmonary hemodynamics. This study evaluates 4D-flow MRI-derived wall shear stress (WSS) for PH detection using the updated 2022 hemodynamic criteria, and the prediction of right ventriculo-pulmonary arterial (RV-PA) uncoupling to assess disease severity. 3D WSS was measured in the main (MPA), right (RPA), and left (LPA) pulmonary arteries in a retrospective validation cohort (41 PH patients, 23 non-PH) and then assessed in a prospective test cohort (23 PH patients, 17 healthy controls). For methodological validation, a patient-specific computational fluid dynamics (CFD) was performed in a subset of 16 patients from the validation cohort. RV-PA uncoupling was assessed on the cine MRI, using RV global longitudinal strain (GLS) < -15.3% and RVSV/RVESV < 1. Both 3D peak and time-averaged WSS were significantly reduced in PH patients compared with healthy controls. Global WSS metrics demonstrated the strongest correlations with invasive hemodynamic parameters, including mPAP (r = -0.75, p < 0.001) and PVR (r = -0.76, p < 0.001). ROC curve analysis identified a peak WSS cutoff of < 0.30 Pa (AUC 0.98) for PH detection, a threshold achieving 90% sensitivity and 100% specificity in the test cohort. Furthermore, a peak WSS threshold of < 0.18 Pa demonstrated excellent discriminative ability for RV-PA uncoupling. These findings support the potential integration of WSS analysis into routine CMR protocols as a non-invasive complement to RHC, showing promise for both diagnosis and a longitudinal biomarker for monitoring PH.
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BibTeX
@article{statton20264dflow,
title = {{4D-Flow MRI-Derived Wall Shear Stress as a Non-Invasive Biomarker for the Detection and Hemodynamic Characterization of Pulmonary Hypertension.}},
author = {Ben Statton and Chlöe Armour and Kai'en Leong and Jan Sedlacik and Alaine Berry and Ning Jin and Daniel Giese and Francesco Lo Guidice and Luke Howard and Deepa Gopalan},
journal = {Pulmonary circulation},
year = {2026},
month = oct,
doi = {10.1002/pul2.70426},
url = {https://europepmc.org/article/MED/42898806},
note = {CC BY},
}
RIS
TY - JOUR
TI - 4D-Flow MRI-Derived Wall Shear Stress as a Non-Invasive Biomarker for the Detection and Hemodynamic Characterization of Pulmonary Hypertension.
AU - Ben Statton
AU - Chlöe Armour
AU - Kai'en Leong
AU - Jan Sedlacik
AU - Alaine Berry
AU - Ning Jin
AU - Daniel Giese
AU - Francesco Lo Guidice
AU - Luke Howard
AU - Deepa Gopalan
PY - 2026
DA - 2026/10/19
JO - Pulmonary circulation
DO - 10.1002/pul2.70426
UR - https://europepmc.org/article/MED/42898806
AB - Invasive right heart catheterization (RHC) remains the reference standard for diagnosing pulmonary hypertension (PH), but there is a pressing need for non-invasive techniques to assess pulmonary hemodynamics. This study evaluates 4D-flow MRI-derived wall shear stress (WSS) for PH detection using the updated 2022 hemodynamic criteria, and the prediction of right ventriculo-pulmonary arterial (RV-PA) uncoupling to assess disease severity. 3D WSS was measured in the main (MPA), right (RPA), and left (LPA) pulmonary arteries in a retrospective validation cohort (41 PH patients, 23 non-PH) and then assessed in a prospective test cohort (23 PH patients, 17 healthy controls). For methodological validation, a patient-specific computational fluid dynamics (CFD) was performed in a subset of 16 patients from the validation cohort. RV-PA uncoupling was assessed on the cine MRI, using RV global longitudinal strain (GLS) < -15.3% and RVSV/RVESV < 1. Both 3D peak and time-averaged WSS were significantly reduced in PH patients compared with healthy controls. Global WSS metrics demonstrated the strongest correlations with invasive hemodynamic parameters, including mPAP (r = -0.75, p < 0.001) and PVR (r = -0.76, p < 0.001). ROC curve analysis identified a peak WSS cutoff of < 0.30 Pa (AUC 0.98) for PH detection, a threshold achieving 90% sensitivity and 100% specificity in the test cohort. Furthermore, a peak WSS threshold of < 0.18 Pa demonstrated excellent discriminative ability for RV-PA uncoupling. These findings support the potential integration of WSS analysis into routine CMR protocols as a non-invasive complement to RHC, showing promise for both diagnosis and a longitudinal biomarker for monitoring PH.
SN - 2045-8932
SN - 2045-8940
ER -