Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension
| Autor: | Ryszard Grzywna, Piotr Szumowski, Dorota Jurgilewicz, Remigiusz Kazimierczyk, Bożena Sobkowicz, Janusz Mysliwiec, Piotr Błaszczak, Lukasz A. Malek, Włodzimierz J. Musiał, Stephan G. Nekolla, Karol Kamiński, Marcin Hładuński |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cardiac output Positron emission tomography Heart Ventricles Hypertension Pulmonary Ventricular Dysfunction Right Hemodynamics Standardized uptake value 030204 cardiovascular system & hematology 030218 nuclear medicine & medical imaging 03 medical and health sciences Coupling 0302 clinical medicine Afterload Predictive Value of Tests Internal medicine medicine.artery medicine Humans Diseases of the circulatory (Cardiovascular) system Radiology Nuclear Medicine and imaging Angiology Pulmonary Arterial Hypertension Radiological and Ultrasound Technology business.industry Research Prognosis ddc Primary pulmonary hypertension Blood pressure medicine.anatomical_structure Ventricle RC666-701 Pulmonary artery Cardiology Ventricular Function Right Cardiovascular magnetic resonance Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiovascular Magnetic Resonance, Vol 23, Iss 1, Pp 1-10 (2021) Journal of Cardiovascular Magnetic Resonance |
| Popis: | BackgroundIn pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients.MethodsTwenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload—pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUVRV/LV. Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration.ResultsCoupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUVRV/LV). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (−)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R2 = 0.68; p ConclusionsCoupling parameters are linked with RV hemodynamics and glucose metabolism in PAH. Combining CMR and hemodynamic measurements offers more comprehensive assessment of RV function required for prognostication of PAH patients.Trial Registration: NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689 |
| Databáze: | OpenAIRE |
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