Imaging and risk stratification in pulmonary arterial hypertension : time to include right ventricular assessment

Abstract

Background: Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).

Methods: Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.

Results: In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.

Conclusion: This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.

Metadata

Authors/Creators:

Alandejani, F.
Hameed, A.
Tubman, E.
Alabed, S. https://orcid.org/0000-0002-9960-7587
Shahin, Y.
Lewis, R.A.
Dwivedi, K.
Mahmood, A.
Middleton, J.
Watson, L.
Alkhanfar, D.
Johns, C.S.
Rajaram, S.
Garg, P.
Condliffe, R.
Elliot, C.A.
Thompson, A.A.R. https://orcid.org/0000-0002-0717-4551
Rothman, A.M.K. https://orcid.org/0000-0002-7847-4500
Charalampopoulos, A.
Lawrie, A.
Wild, J.M. https://orcid.org/0000-0002-7246-8660
Swift, A.J.
Kiely, D.G.

© 2022 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Keywords:

pulmonary hypertension; pulmonary arterial hypertension (PAH); right atrial area; right ventricular (RV); risk stratification; cardiac magnetic resonance imaging (cMRI)

Dates: