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. 2022 Mar 25:9:797561.
doi: 10.3389/fcvm.2022.797561. eCollection 2022.

Imaging and Risk Stratification in Pulmonary Arterial Hypertension: Time to Include Right Ventricular Assessment

Faisal Alandejani  1 , Abdul Hameed  1   2 , Euan Tubman  1 , Samer Alabed  1   3 , Yousef Shahin  1   3 , Robert A Lewis  1   2 , Krit Dwivedi  1 , Aqeeb Mahmood  1 , Jennifer Middleton  1   2 , Lisa Watson  2 , Dheyaa Alkhanfar  1 , Christopher S Johns  1 , Smitha Rajaram  1 , Pankaj Garg  4 , Robin Condliffe  2 , Charlie A Elliot  2 , A A Roger Thompson  1   2 , Alexander M K Rothman  1   2   3 , Athanasios Charalampopoulos  2 , Allan Lawrie  1 , Jim M Wild  1   3 , Andrew J Swift  1   3 , David G Kiely  1   2   3
Affiliations

Imaging and Risk Stratification in Pulmonary Arterial Hypertension: Time to Include Right Ventricular Assessment

Faisal Alandejani et al. Front Cardiovasc Med. .

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.

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

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Bar charts displaying cardiac MRI RA area thresholds based on ESC/ERS guidelines and RV metrics based on published thresholds, and percentage mortality at 1-year for treatment naïve patients at (top) baseline (n = 311) and (bottom) follow-up (n = 121). MRI, magnetic resonance imaging; RA, right atrial; ESC/ERS, European Society of Cardiology and European Respiratory Society; RV, right ventricular; %pred, percentage predicted for age and sex; RVESVi, right ventricular end-systolic volume index; RVEF, right ventricular ejection fraction.
FIGURE 2
FIGURE 2
Kaplan–Meier survival curves for treatment naïve patients for RA area at baseline (A), RA area at follow-up cardiac MRI (B), transition of risk between baseline and follow-up cardiac MRI for RA area (C), RVESVi %pred at baseline (D), RVESVi %pred at follow-up cardiac MRI (E), and transition of risk between baseline and follow-up cardiac MRI for RVESVi %pred (F). MRI, magnetic resonance imaging; RA, right atrial; %pred, percentage predicted for age and sex; RVESVi, right ventricular end-systolic volume index.
FIGURE 3
FIGURE 3
LOESS regression analysis for treatment naïve patients for RA area at baseline (top) and follow-up (bottom). RA, right atrial; LOESS, locally weighted scatterplot smoothing.
See this image and copyright information in PMC

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