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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.

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organization
publishing date
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
Elsevier Inc.
external identifiers
  • scopus:85054068635
ISSN
1551-7136
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
2019-01-06 14:08:52
@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         = {1551-7136},
  keyword      = {Cardiac magnetic resonance imaging,Left atrial volume,Pulmonary hypertension,Right atrial volume,Transplantation-free survival},
  language     = {eng},
  number       = {5},
  pages        = {864--875},
  publisher    = {Elsevier 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},
  volume       = {5},
  year         = {2018},
}