Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre‐capillary pulmonary hypertension. (19th June 2018)

• Record Type: Journal Article
• Authors: Bredfelt, Anna; Rådegran, Göran; Hesselstrand, Roger; Arheden, Håkan; Ostenfeld, Ellen
• Is Part Of: ESC heart failure. Volume 5:Number 5(2018)
• Page Start: 864
• Page End: 875
• Publication Date: 2018-06-19
• Subjects: Pulmonary hypertension -- Right atrial volume -- Left atrial volume -- Transplantation‐free survival -- Cardiac magnetic resonance imaging; Heart failure -- Periodicals; 616.129005
• DOI: 10.1002/ehf2.12304
• Languages: English
• ISSNs: 2055-5822

Abstract

Abstract: Aims: Pre‐capillary pulmonary hypertension (PHpre‐cap ) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc‐PAH). Whether cardiac magnetic resonance (CMR)‐based quantification of atrial volumes in PHpre‐cap is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PHpre‐cap, (ii) atrial volumes differ among four unmatched major PHpre‐cap subgroups, and (iii) atrial volumes differ between SSc‐PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR). Methods and results: Seventy‐five PHpre‐cap patients (57 ± 19 years, 53 female, 43 de novo) with CMR and right heart catheterization were retrospectively included. Short‐axis stacks of cine images were analysed, and right and left atrial maximum (RAVmax and LAVmax ) and minimum volume (RAVmin and LAVmin ) were indexed for body surface area. Increased (mean + 2 SD) and reduced (mean – 2 SD) volumes were predefined from CMR normal values. Transplantation‐free survival was lower in patients with increased RAVmax than in those with normal [hazard ratio (HR) = 2.1, 95% confidence interval (CI) 1.1–4.0] but did not differ between those with reduced LAVmax and normal (HR 2.0, 95% CI 0.8–5.1). RAVmax and RAVmin showed no differences among unmatched or matched groups ( P = ns). When matched for PVR, LAVmax, LAVmin, and pulmonary artery wedge pressure were reduced in SSc‐PAH compared with IPAH/FPAH (95% CI 0.3–21.4, 95% CI 0.8–19.6, and 95% CI 2–7, respectively). Conclusions: Patients with PHpre‐cap and increased right atrial volume measured with CMR had worse clinical outcome. When matched for PVR, left atrial volume was lower in SSc‐PAH than in IPAH/FPAH, consistent with left‐sided underfilling, indicating a potential differentiator between the groups.