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Observational Study
. 2021 May 10;23(1):49.
doi: 10.1186/s12968-021-00743-2.

Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension

Remigiusz Kazimierczyk  1 , Lukasz A Malek  2 , Piotr Szumowski  3   4 , Stephan G Nekolla  5 , Piotr Blaszczak  6 , Dorota Jurgilewicz  4 , Marcin Hladunski  3   4 , Bozena Sobkowicz  1 , Janusz Mysliwiec  4 , Ryszard Grzywna  5 , Wlodzimierz J Musial  1 , Karol A Kaminski  7   8
Affiliations
Observational Study

Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension

Remigiusz Kazimierczyk et al. J Cardiovasc Magn Reson. .

Abstract

Background: In 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.

Methods: Twenty-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.

Results: Coupling 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 < 0.001).

Conclusions: Coupling 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.

Keywords: Cardiovascular magnetic resonance; Coupling; Positron emission tomography; Primary pulmonary hypertension; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Spearman correlations between right ventricular (RV) global longitudinal strain (GLS) (from cardiovascular magnetic resonance (CMR)) and a mean pulmonary artery pressure (mPAP) and b pulmonary vascular resistance (PVR), both obtained from right heart catheterization (RHC) in the pulmonary artery hypertension (PAH) group. CMR cardiac magnetic resonance; GLS global longitudinal strain; mPAP mean pulmonary arterial hypertension; PAH pulmonary arterial hypertension; PVR pulmonary vascular resistance, RHC right heart catheterization; RV right ventricle.
Fig. 2
Fig. 2
Spearman correlation between RV GLS/PASP and SUVRV/LV PAH group. GLS global longitudinal strain; LV left ventricle; PAH pulmonary arterial hypertension; PASP pulmonary artery systolic pressure; RV right ventricle; SUV standardized uptake value.
Fig. 3
Fig. 3
Kaplan–Meier curves presenting deterioration free survival in pulmonary artery hypertension (PAH) patients basing on RV GLS/PASP cut-off value, log-rank test, p = 0.0008. °—complete events, +—censored events
See this image and copyright information in PMC

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