Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre-capillary pulmonary hypertension
Bredfelt, Anna ; Rådegran, Göran LU ; Hesselstrand, Roger LU ; Arheden, Håkan LU and Ostenfeld, Ellen LU
(2018)
In ESC Heart Failure
5(5).
p.864-875
- Abstract
Aims: Pre-capillary pulmonary hypertension (PHpre-cap) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). Whether cardiac magnetic resonance (CMR)-based quantification of atrial volumes in PHpre-cap is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PHpre-cap, (ii) atrial volumes differ among four unmatched major PHpre-cap subgroups, and (iii) atrial volumes differ between SSc-PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR). Methods and results: Seventy-five... (More)
Aims: Pre-capillary pulmonary hypertension (PHpre-cap) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). Whether cardiac magnetic resonance (CMR)-based quantification of atrial volumes in PHpre-cap is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PHpre-cap, (ii) atrial volumes differ among four unmatched major PHpre-cap subgroups, and (iii) atrial volumes differ between SSc-PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR). Methods and results: Seventy-five PHpre-cap patients (57 ± 19 years, 53 female, 43 de novo) with CMR and right heart catheterization were retrospectively included. Short-axis stacks of cine images were analysed, and right and left atrial maximum (RAVmax and LAVmax) and minimum volume (RAVmin and LAVmin) were indexed for body surface area. Increased (mean + 2 SD) and reduced (mean – 2 SD) volumes were predefined from CMR normal values. Transplantation-free survival was lower in patients with increased RAVmax than in those with normal [hazard ratio (HR) = 2.1, 95% confidence interval (CI) 1.1–4.0] but did not differ between those with reduced LAVmax and normal (HR 2.0, 95% CI 0.8–5.1). RAVmax and RAVmin showed no differences among unmatched or matched groups (P = ns). When matched for PVR, LAVmax, LAVmin, and pulmonary artery wedge pressure were reduced in SSc-PAH compared with IPAH/FPAH (95% CI 0.3–21.4, 95% CI 0.8–19.6, and 95% CI 2–7, respectively). Conclusions: Patients with PHpre-cap and increased right atrial volume measured with CMR had worse clinical outcome. When matched for PVR, left atrial volume was lower in SSc-PAH than in IPAH/FPAH, consistent with left-sided underfilling, indicating a potential differentiator between the groups.
(Less)
- author
- Bredfelt, Anna
; Rådegran, Göran
LU
; Hesselstrand, Roger
LU
; Arheden, Håkan
LU
and Ostenfeld, Ellen
LU
- organization
- publishing date
- 2018
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac magnetic resonance imaging, Left atrial volume, Pulmonary hypertension, Right atrial volume, Transplantation-free survival
- in
- ESC Heart Failure
- volume
- 5
- issue
- 5
- pages
- 12 pages
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:29916558
- scopus:85054068635
- ISSN
- 2055-5822
- DOI
- 10.1002/ehf2.12304
- language
- English
- LU publication?
- yes
- id
- abf87ee2-cbfc-48be-8d46-cde0ec9dfdd3
- date added to LUP
- 2018-10-09 12:16:32
- date last changed
- 2024-04-01 10:33:34
@article{abf87ee2-cbfc-48be-8d46-cde0ec9dfdd3,
abstract = {{<p>Aims: Pre-capillary pulmonary hypertension (PH<sub>pre-cap</sub>) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). Whether cardiac magnetic resonance (CMR)-based quantification of atrial volumes in PH<sub>pre-cap</sub> is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PH<sub>pre-cap</sub>, (ii) atrial volumes differ among four unmatched major PH<sub>pre-cap</sub> subgroups, and (iii) atrial volumes differ between SSc-PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR). Methods and results: Seventy-five PH<sub>pre-cap</sub> patients (57 ± 19 years, 53 female, 43 de novo) with CMR and right heart catheterization were retrospectively included. Short-axis stacks of cine images were analysed, and right and left atrial maximum (RAV<sub>max</sub> and LAV<sub>max</sub>) and minimum volume (RAV<sub>min</sub> and LAV<sub>min</sub>) were indexed for body surface area. Increased (mean + 2 SD) and reduced (mean – 2 SD) volumes were predefined from CMR normal values. Transplantation-free survival was lower in patients with increased RAV<sub>max</sub> than in those with normal [hazard ratio (HR) = 2.1, 95% confidence interval (CI) 1.1–4.0] but did not differ between those with reduced LAV<sub>max</sub> and normal (HR 2.0, 95% CI 0.8–5.1). RAV<sub>max</sub> and RAV<sub>min</sub> showed no differences among unmatched or matched groups (P = ns). When matched for PVR, LAV<sub>max</sub>, LAV<sub>min</sub>, and pulmonary artery wedge pressure were reduced in SSc-PAH compared with IPAH/FPAH (95% CI 0.3–21.4, 95% CI 0.8–19.6, and 95% CI 2–7, respectively). Conclusions: Patients with PH<sub>pre-cap</sub> and increased right atrial volume measured with CMR had worse clinical outcome. When matched for PVR, left atrial volume was lower in SSc-PAH than in IPAH/FPAH, consistent with left-sided underfilling, indicating a potential differentiator between the groups.</p>}},
author = {{Bredfelt, Anna and Rådegran, Göran and Hesselstrand, Roger and Arheden, Håkan and Ostenfeld, Ellen}},
issn = {{2055-5822}},
keywords = {{Cardiac magnetic resonance imaging; Left atrial volume; Pulmonary hypertension; Right atrial volume; Transplantation-free survival}},
language = {{eng}},
number = {{5}},
pages = {{864--875}},
publisher = {{John Wiley & Sons Inc.}},
series = {{ESC Heart Failure}},
title = {{Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre-capillary pulmonary hypertension}},
url = {{http://dx.doi.org/10.1002/ehf2.12304}},
doi = {{10.1002/ehf2.12304}},
volume = {{5}},
year = {{2018}},
}