Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response.
Heart Failure
Magnetic Resonance Imaging
Pulmonary Arterial Hypertension
Journal
Heart (British Cardiac Society)
ISSN: 1468-201X
Titre abrégé: Heart
Pays: England
ID NLM: 9602087
Informations de publication
Date de publication:
11 08 2022
11 08 2022
Historique:
received:
22
12
2021
accepted:
29
03
2022
pubmed:
6
5
2022
medline:
16
8
2022
entrez:
5
5
2022
Statut:
epublish
Résumé
To determine the prognostic value of patterns of right ventricular adaptation in patients with pulmonary arterial hypertension (PAH), assessed using cardiac magnetic resonance (CMR) imaging at baseline and follow-up. Patients attending the Sheffield Pulmonary Vascular Disease Unit with suspected pulmonary hypertension were recruited into the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral Centre) Registry. With exclusion of congenital heart disease, consecutive patients with PAH were followed up until the date of census or death. Right ventricular end-systolic volume index adjusted for age and sex and ventricular mass index were used to categorise patients into four different volume/mass groups: low-volume-low-mass, low-volume-high-mass, high-volume-low-mass and high-volume-high-mass. The prognostic value of the groups was assessed with one-way analysis of variance and Kaplan-Meier plots. Transition of the groups was studied. A total of 505 patients with PAH were identified, 239 (47.3%) of whom have died at follow-up (median 4.85 years, IQR 4.05). The mean age of the patients was 59±16 and 161 (32.7%) were male. Low-volume-low-mass was associated with CMR and right heart catheterisation metrics predictive of improved prognosis. There were 124 patients who underwent follow-up CMR (median 1.11 years, IQR 0.78). At both baseline and follow-up, the high-volume-low-mass group had worse prognosis than the low-volume-low-mass group (p<0.001). With PAH therapy, 73.5% of low-volume-low-mass patients remained in this group, whereas only 17.4% of high-volume-low-mass patients transitioned into low-volume-low-mass. Right ventricular adaptation assessed using CMR has prognostic value in patients with PAH. Patients with maladaptive remodelling (high-volume-low-mass) are at high risk of treatment failure.
Identifiants
pubmed: 35512982
pii: heartjnl-2021-320733
doi: 10.1136/heartjnl-2021-320733
pmc: PMC9380507
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1392-1400Subventions
Organisme : Wellcome Trust
ID : 205188/Z/16/Z
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/18/13/33281
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M008894/1
Pays : United Kingdom
Organisme : British Heart Foundation
ID : SP/14/6/31350
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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