Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response. Issue 17 (5th May 2022)

• Record Type: Journal Article
• Authors: Goh, Ze Ming; Balasubramanian, Nithin; Alabed, Samer; Dwivedi, Krit; Shahin, Yousef; Rothman, Alexander M K; Garg, Pankaj; Lawrie, Allan; Capener, David; Thompson, A A Roger; Alandejani, Faisal; Wild, Jim M; Johns, Christopher S; Lewis, Robert A; Gosling, Rebecca; Sharkey, Michael; Condliffe, Robin; Kiely, David G; Swift, Andrew J
• Is Part Of: Heart. Volume 108:Issue 17(2022)
• Page Start: 1392
• Page End: 1400
• Publication Date: 2022-05-05
• Subjects: Magnetic Resonance Imaging -- Pulmonary Arterial Hypertension -- Heart Failure; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2021-320733
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To determine the prognostic value of patterns of right ventricular adaptation in patients with pulmonary arterial hypertension (PAH), assessed using cardiac magnetic resonance (CMR) imaging at baseline and follow-up. Methods: Patients attending the Sheffield Pulmonary Vascular Disease Unit with suspected pulmonary hypertension were recruited into the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral Centre) Registry. With exclusion of congenital heart disease, consecutive patients with PAH were followed up until the date of census or death. Right ventricular end-systolic volume index adjusted for age and sex and ventricular mass index were used to categorise patients into four different volume/mass groups: low-volume-low-mass, low-volume-high-mass, high-volume-low-mass and high-volume-high-mass. The prognostic value of the groups was assessed with one-way analysis of variance and Kaplan-Meier plots. Transition of the groups was studied. Results: A total of 505 patients with PAH were identified, 239 (47.3%) of whom have died at follow-up (median 4.85 years, IQR 4.05). The mean age of the patients was 59±16 and 161 (32.7%) were male. Low-volume-low-mass was associated with CMR and right heart catheterisation metrics predictive of improved prognosis. There were 124 patients who underwent follow-up CMR (median 1.11 years, IQR 0.78). At both baseline and follow-up, the high-volume-low-mass group had worse prognosis than the low-volume-low-mass group (p<0.001). With PAH therapy, 73.5% of low-volume-low-mass patients remained in this group, whereas only 17.4% of high-volume-low-mass patients transitioned into low-volume-low-mass. Conclusions: Right ventricular adaptation assessed using CMR has prognostic value in patients with PAH. Patients with maladaptive remodelling (high-volume-low-mass) are at high risk of treatment failure.