Feasibility of quantitative pulmonary function imaging in real-world cardiovascular magnetic resonance

Providing insights into the feasibility of pulmonary function assessment in real-world cardiovascular magnetic resonance (CMR) practice by applying Phase-REsolved FUnctional Lung imaging (PREFUL). We retrospectively analyzed consecutive patients who underwent PREFUL imaging in addition to routine 1.5T CMR between September 2023 and January 2024. PREFUL was acquired in three coronal slices, with a prototype tool used to derive quantitative perfusion and ventilation defect percentages (QDP and VDP, respectively). Cardiac function was assessed from short-axis cine images. Subgroup analyses included patients with primary pulmonary disease and reduced left ventricular ejection fraction (LVEF). Statistical analyses comprised linear regression, correlation analysis, and Kruskal-Wallis test. The final cohort included N = 172 patients (74 females), median age 60 years (IQR 46-71). PREFUL was feasible in all cases (mean scan time 60 s/slice). Multivariable regression with bootstrap-based backward selection showed associations of QDP with LVEF, pulmonary disease, age, and BMI (all p ≤ 0.005), while VDP was associated with pulmonary disease, age, and male sex (all p < 0.001). QDP correlated negatively with LV stroke volume (ρ (Spearman's rho) - 0.336, p < 0.001) and cardiac output (ρ - 0.360; p < 0.001) and was higher in patients with LVEF < 50% (p < 0.001). Patients with primary pulmonary disease had higher QDP (p = 0.005) and VDP (p = 0.036). No correlations between cardiac function and VDP were detected (all p > 0.05). Application of PREFUL is feasible and fast in CMR routine. While QDP and VDP are affected by pulmonary disease, QDP is additionally associated with markers of cardiac function and was higher in patients with reduced LVEF.