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Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension

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Abstract

Objectives

To evaluate whether careful exercise training improves pulmonary perfusion and blood flow in patients with pulmonary hypertension (PH), as assessed by magnetic resonance imaging (MR).

Methods

Twenty patients with pulmonary arterial hypertension or inoperable chronic thromboembolic PH on stable medication were randomly assigned to control (n = 10) or training groups (n = 10). Training group patients received in-hospital exercise training; patients of the sedentary control group received conventional rehabilitation. Medication remained unchanged during the study period. Changes of 6-min walking distance (6MWD), MR pulmonary flow (peak velocity) and MR perfusion (pulmonary blood volume) were assessed from baseline to week 3.

Results

After 3 weeks of training, increases in mean 6MWD (P = 0.004) and mean MR flow peak velocity (P = 0.012) were significantly greater in the training group. Training group patients had significantly improved 6MWD (P = 0.008), MR flow (peak velocity −9.7 ± 8.6 cm/s, P = 0.007) and MR perfusion (pulmonary blood volume +2.2 ± 2.7 mL/100 mL, P = 0.017), whereas the control group showed no significant changes.

Conclusion

The study indicates that respiratory and physical exercise may improve pulmonary perfusion in patients with PH. Measurement of MR parameters of pulmonary perfusion might be an interesting new method to assess therapy effects in PH. The results of this initial study should be confirmed in a larger study group.

Key Points

• Quantification of magnetic resonance perfusion is feasible in patients with pulmonary hypertension.

• Quantified magnetic resonance perfusion may become useful for non-invasive monitoring of treatment.

• Quantification of lung perfusion allows new insights into lung (patho-)physiology of PH.

• Careful exercise training improves pulmonary perfusion and blood flow in patients with PH.

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Abbreviations

3D:

three dimensional

MR:

magnetic resonance imaging

MTT:

mean transit time

PAH:

pulmonary arterial hypertension

PBF:

pulmonary blood flow

PBV:

pulmonary blood volume

ROI:

region of interest

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Acknowledgments

This work was supported by the German National Research Agency (DFG): “Image-based V/Q analysis” (FOR 474-2). The authors are grateful to Mrs. Susanne Yubai and Mrs. Kathleen Knauer for excellent performance of the examinations. The authors want to thank all patients that participated in the study.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Sebastian Ley, Julia Ley-Zaporozhan & Hans-Ulrich Kauczor

  2. Department of Radiology (E010), DKFZ, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Sebastian Ley, Julia Ley-Zaporozhan & Hans-Ulrich Kauczor

  3. Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Christian Fink

  4. Department of Medical Physics in Radiology (E020), DKFZ, INF 280, 69120, Heidelberg, Germany

    Frank Risse

  5. Centre for Pulmonary Hypertension, Thoraxklinik at the University Hospital Heidelberg, Amalienstraße 5, 69126, Heidelberg, Germany

    Nicola Ehlken & Ekkehard Gruenig

  6. Department of Human Genetics, University of Heidelberg, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany

    Christine Fischer

  7. Department of Pneumology, University Hospital of Hamburg, Hamburg, Germany

    Hans Klose

Authors
  1. Sebastian Ley
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  2. Christian Fink
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  6. Julia Ley-Zaporozhan
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  7. Hans-Ulrich Kauczor
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  8. Hans Klose
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  9. Ekkehard Gruenig
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Corresponding author

Correspondence to Sebastian Ley.

Additional information

Hans Klose and Ekkehard Gruenig contributed equally.

This paper was awarded with the scientific presentation award “Chest” during the ECR 2008.

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Ley, S., Fink, C., Risse, F. et al. Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension. Eur Radiol 23, 324–331 (2013). https://doi.org/10.1007/s00330-012-2606-z

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  • DOI: https://doi.org/10.1007/s00330-012-2606-z

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