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Left ventricular dysfunction in pulmonary arterial hypertension is attributed to underfilling rather than intrinsic myocardial disease : a CMR 2D phase contrast study

Venkateshvaran, Ashwin LU orcid ; Bohlin, Jessica ; Kjellström, Barbro LU ; Bergström, Elsa LU orcid ; Nelsson, Anders LU ; Werther Evaldsson, Anna LU orcid ; Rådegran, Göran LU ; Arheden, Håkan LU and Ostenfeld, Ellen LU orcid (2024) In Scientific Reports 14(1).
Abstract

The pathophysiology underlying impaired LV function in PAH remains unclear, with some studies implicating intrinsic myocardial dysfunction and others pointing to LV underfilling. Evaluation of pulmonary vein area (PVA) and flow may offer novel, mechanistic insight by distinguishing elevated LV filling pressure common in myocardial dysfunction from LV underfilling. This study aimed to elucidate LV filling physiology in PAH by assessing PVA and flow using cardiac magnetic resonance (CMR) and compare pulmonary vein flow in PAH with HFrEF as a model representing elevated filling pressures, in addition to healthy controls. Patients with PAH or heart failure with reduced ejection fraction (HFrEF) referred for CMR were retrospectively... (More)

The pathophysiology underlying impaired LV function in PAH remains unclear, with some studies implicating intrinsic myocardial dysfunction and others pointing to LV underfilling. Evaluation of pulmonary vein area (PVA) and flow may offer novel, mechanistic insight by distinguishing elevated LV filling pressure common in myocardial dysfunction from LV underfilling. This study aimed to elucidate LV filling physiology in PAH by assessing PVA and flow using cardiac magnetic resonance (CMR) and compare pulmonary vein flow in PAH with HFrEF as a model representing elevated filling pressures, in addition to healthy controls. Patients with PAH or heart failure with reduced ejection fraction (HFrEF) referred for CMR were retrospectively reviewed, and healthy controls were included as reference. Pulmonary vein S, D and A-wave were compared between groups. Associations between pulmonary vein area (PVA) by CMR and echocardiographic indices of LV filling pressure were evaluated. Nineteen patients with PAH, 25 with HFrEF and 24 controls were included. Both PAH and HFrEF had lower ejection fraction and S-wave velocity than controls. PAH displayed smaller LV end-diastolic volumes than controls, while HFrEF demonstrated larger PVA and higher A-wave reversal. PVA was associated with mitral E/e' ratio (r
2  = 0.10; p = 0.03), e' velocity (r
2  = 0.23; p = 0.001) and left atrial volume (r
2  = 0.07; p = 0.005). Among PAH, PVA was not associated with LV-GLS. A PVA cut-off of 2.3cm
2 displayed 87% sensitivity and 72% specificity to differentiate HFrEF and PAH (AUC = 0.82). PAH displayed lower pulmonary vein S-wave velocity, smaller LV volume and reduced function compared with controls. Reduced LV function in PAH may be owing to underfilling rather than intrinsic myocardial disease. PVA demonstrates promise as a novel, non-invasive imaging marker to assess LV filling status.

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; ; ; ; ; ; ; and
organization
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type
Contribution to journal
publication status
published
subject
keywords
Humans, Male, Female, Middle Aged, Ventricular Dysfunction, Left/physiopathology, Pulmonary Arterial Hypertension/physiopathology, Retrospective Studies, Stroke Volume, Aged, Pulmonary Veins/diagnostic imaging, Adult, Magnetic Resonance Imaging/methods, Heart Failure/physiopathology, Echocardiography/methods, Ventricular Function, Left/physiology
in
Scientific Reports
volume
14
issue
1
article number
17280
publisher
Nature Publishing Group
external identifiers
  • pmid:39068288
ISSN
2045-2322
DOI
10.1038/s41598-024-68254-5
language
English
LU publication?
yes
additional info
© 2024. The Author(s).
id
1c8a48f5-c1a4-47e0-a6dc-da8e1b61129e
date added to LUP
2024-07-29 21:08:14
date last changed
2024-07-30 08:57:13
@article{1c8a48f5-c1a4-47e0-a6dc-da8e1b61129e,
  abstract     = {{<p>The pathophysiology underlying impaired LV function in PAH remains unclear, with some studies implicating intrinsic myocardial dysfunction and others pointing to LV underfilling. Evaluation of pulmonary vein area (PVA) and flow may offer novel, mechanistic insight by distinguishing elevated LV filling pressure common in myocardial dysfunction from LV underfilling. This study aimed to elucidate LV filling physiology in PAH by assessing PVA and flow using cardiac magnetic resonance (CMR) and compare pulmonary vein flow in PAH with HFrEF as a model representing elevated filling pressures, in addition to healthy controls. Patients with PAH or heart failure with reduced ejection fraction (HFrEF) referred for CMR were retrospectively reviewed, and healthy controls were included as reference. Pulmonary vein S, D and A-wave were compared between groups. Associations between pulmonary vein area (PVA) by CMR and echocardiographic indices of LV filling pressure were evaluated. Nineteen patients with PAH, 25 with HFrEF and 24 controls were included. Both PAH and HFrEF had lower ejection fraction and S-wave velocity than controls. PAH displayed smaller LV end-diastolic volumes than controls, while HFrEF demonstrated larger PVA and higher A-wave reversal. PVA was associated with mitral E/e' ratio (r <br>
 2  = 0.10; p = 0.03), e' velocity (r <br>
 2  = 0.23; p = 0.001) and left atrial volume (r <br>
 2  = 0.07; p = 0.005). Among PAH, PVA was not associated with LV-GLS. A PVA cut-off of 2.3cm <br>
 2 displayed 87% sensitivity and 72% specificity to differentiate HFrEF and PAH (AUC = 0.82). PAH displayed lower pulmonary vein S-wave velocity, smaller LV volume and reduced function compared with controls. Reduced LV function in PAH may be owing to underfilling rather than intrinsic myocardial disease. PVA demonstrates promise as a novel, non-invasive imaging marker to assess LV filling status.<br>
 </p>}},
  author       = {{Venkateshvaran, Ashwin and Bohlin, Jessica and Kjellström, Barbro and Bergström, Elsa and Nelsson, Anders and Werther Evaldsson, Anna and Rådegran, Göran and Arheden, Håkan and Ostenfeld, Ellen}},
  issn         = {{2045-2322}},
  keywords     = {{Humans; Male; Female; Middle Aged; Ventricular Dysfunction, Left/physiopathology; Pulmonary Arterial Hypertension/physiopathology; Retrospective Studies; Stroke Volume; Aged; Pulmonary Veins/diagnostic imaging; Adult; Magnetic Resonance Imaging/methods; Heart Failure/physiopathology; Echocardiography/methods; Ventricular Function, Left/physiology}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Scientific Reports}},
  title        = {{Left ventricular dysfunction in pulmonary arterial hypertension is attributed to underfilling rather than intrinsic myocardial disease : a CMR 2D phase contrast study}},
  url          = {{http://dx.doi.org/10.1038/s41598-024-68254-5}},
  doi          = {{10.1038/s41598-024-68254-5}},
  volume       = {{14}},
  year         = {{2024}},
}