Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization

Autor: Håkan Arheden, Göran Rådegran, Ellen Ostenfeld, Anna Bredfelt, Erik Hedström
Rok vydání: 2019
Předmět:
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Cardiac Catheterization
Magnetic Resonance Spectroscopy
Hypertension
Pulmonary
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Cardiac magnetic resonance imaging
medicine.artery
Internal medicine
Original Research Articles
Medicine
Humans
030212 general & internal medicine
Original Research Article
Right heart catheterization
Outcome
Pulmonary Arterial Hypertension
Ejection fraction
medicine.diagnostic_test
business.industry
Central venous pressure
Stroke volume
medicine.disease
Tricuspid Valve Insufficiency
medicine.anatomical_structure
lcsh:RC666-701
Heart failure
Heart catheterization
Pulmonary artery
Cardiology
Vascular resistance
Cardiology and Cardiovascular Medicine
business
Tricuspid valve regurgitation
Zdroj: ESC Heart Failure
ESC Heart Failure, Vol 7, Iss 4, Pp 1653-1663 (2020)
ISSN: 2055-5822
Popis: Aims Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event‐free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation. Methods and results Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0–4.4) and TR fraction (TR%; 1.6, 95% CI 0.8–3.3) above median. TRV and TR% correlated with right ventricular (RV) end‐diastolic (TRV r = 0.50; TR% r = 0.39) and end‐systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = −0.32; TR% r = −0.54), pulmonary artery stroke volume (TRV r = −0.32; TR% r = −0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = −0.56; TR% r = −0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r 2 = 0.38; r 2 = 0.48). Conclusions A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.
Databáze: OpenAIRE
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