Risk assessment in PAH using quantitative CMR tricuspid regurgitation : relation to heart catheterization
Hedström, Erik LU
; Bredfelt, Anna
; Rådegran, Göran
LU
; Arheden, Håkan
LU
and Ostenfeld, Ellen
LU
(2020)
In ESC Heart Failure
7(4).
p.1653-1663
- Abstract
AIMS: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event-free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation.
METHODS AND RESULTS: Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were... (More)
AIMS: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event-free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation.
METHODS AND RESULTS: Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0-4.4) and TR fraction (TR%; 1.6, 95% CI 0.8-3.3) above median. TRV and TR% correlated with right ventricular (RV) end-diastolic (TRV r = 0.50; TR% r = 0.39) and end-systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = -0.32; TR% r = -0.54), pulmonary artery stroke volume (TRV r = -0.32; TR% r = -0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = -0.56; TR% r = -0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r2 = 0.38; r2 = 0.48).
CONCLUSIONS: A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.
(Less)
- author
- Hedström, Erik
LU
; Bredfelt, Anna
; Rådegran, Göran
LU
; Arheden, Håkan
LU
and Ostenfeld, Ellen
LU
- organization
- publishing date
- 2020-08
- type
- Contribution to journal
- publication status
- published
- subject
- in
- ESC Heart Failure
- volume
- 7
- issue
- 4
- pages
- 11 pages
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:32372555
- scopus:85085086766
- ISSN
- 2055-5822
- DOI
- 10.1002/ehf2.12720
- language
- English
- LU publication?
- yes
- id
- 27e5d221-9450-4e5b-b26b-d4b9649957a2
- date added to LUP
- 2020-05-14 18:09:54
- date last changed
- 2024-05-01 10:06:09
@article{27e5d221-9450-4e5b-b26b-d4b9649957a2,
abstract = {{<p>AIMS: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event-free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation.</p><p>METHODS AND RESULTS: Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0-4.4) and TR fraction (TR%; 1.6, 95% CI 0.8-3.3) above median. TRV and TR% correlated with right ventricular (RV) end-diastolic (TRV r = 0.50; TR% r = 0.39) and end-systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = -0.32; TR% r = -0.54), pulmonary artery stroke volume (TRV r = -0.32; TR% r = -0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = -0.56; TR% r = -0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r2 = 0.38; r2 = 0.48).</p><p>CONCLUSIONS: A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.</p>}},
author = {{Hedström, Erik and Bredfelt, Anna and Rådegran, Göran and Arheden, Håkan and Ostenfeld, Ellen}},
issn = {{2055-5822}},
language = {{eng}},
number = {{4}},
pages = {{1653--1663}},
publisher = {{John Wiley & Sons Inc.}},
series = {{ESC Heart Failure}},
title = {{Risk assessment in PAH using quantitative CMR tricuspid regurgitation : relation to heart catheterization}},
url = {{http://dx.doi.org/10.1002/ehf2.12720}},
doi = {{10.1002/ehf2.12720}},
volume = {{7}},
year = {{2020}},
}