The Value of Hemodynamic Measurements or Cardiac MRI in the Follow-up of Patients With Idiopathic Pulmonary Arterial Hypertension.

Autor:	van der Bruggen CE; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Handoko ML; Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bogaard HJ; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Marcus JT; Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Oosterveer FPT; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Meijboom LJ; Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Westerhof BE; Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Center, University of Twente, Enschede, The Netherlands., Vonk Noordegraaf A; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., de Man FS; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. Electronic address: fs.deman@amsterdamumc.nl.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2021 Apr; Vol. 159 (4), pp. 1575-1585. Date of Electronic Publication: 2020 Nov 14.
DOI:	10.1016/j.chest.2020.10.077
Abstrakt:	Background: Treatment of patients with pulmonary arterial hypertension (PAH) is conventionally based on functional plus invasive measurements obtained during right heart catheterization (RHC). Whether risk assessment during repeated measurements could also be performed on the basis of imaging parameters is unclear, as a direct comparison of strategies is lacking. Research Question: How does the predictive value of noninvasive parameters compare with that of invasive hemodynamic measurements 1 year after the diagnosis of idiopathic PAH? Study Design and Methods: One hundred and eighteen patients with idiopathic PAH who underwent RHC and cardiac MRI (CMR) were included in this study (median time between baseline evaluation and first parameter measures, 1.0 [0.8-1.2] years). Forty-four patients died or underwent lung transplantation. Forward Cox regression analyses were done to determine the best predictive functional, hemodynamic, and/or imaging model. Patients were classified as high risk if the event occurred < 5 years after diagnosis (n = 24), whereas patients without event were classified as low risk. Results: A prognostic model based on age, sex, and absolute values at follow-up of functional parameters (6-min walk distance) performed well (Akaike information criterion [AIC], 279; concordance, 0.67). Predictive models with only hemodynamic (right atrial pressure, mixed venous oxygen saturation; AIC, 322; concordance, 0.66) or imaging parameters (right ventricular ejection fraction; AIC, 331; concordance, 0.63) at 1 year of follow-up performed similarly. The predictive value improved when functional data were combined with either hemodynamic data (AIC, 268; concordance, 0.69) or imaging data (AIC, 273; concordance, 0.70). A model composed of functional, hemodynamic, and imaging data performed only marginally better (AIC, 266; concordance, 0.69). Finally, changes between baseline and 1-year follow-up were observed for multiple hemodynamic and CMR parameters; only a change in CMR parameters was of prognostic predictive value. Interpretation: At 1 year of follow-up, risk assessment based on CMR is at least equal to risk assessment based on RHC. In this study, only changes in CMR, but not hemodynamic parameters, were of prognostic predictive value during the first year of follow-up. (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu