Journal Article

Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response

Wild, Jim M, Johns, Christopher S, Sharkey, Michael, Shahin, Yousef, Goh, Ze Ming, Garg, Pankaj, Capener, David, Thompson, A A Roger, Alandejani, Faisal, Alabed, Samer, Gosling, Rebecca, Kiely, David G, Balasubramanian, Nithin, Dwivedi, Krit, Rothman, Alexander M K, Lewis, Robert A, Swift, Andrew J, Lawrie, Allan, Condliffe, Robin

2022

Overview

ObjectivesTo 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.MethodsPatients 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.ResultsA 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.ConclusionsRight 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.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Cardiac catheterization / Demographics / Ejection fraction / Familial Primary Pulmonary Hypertension / Female / Heart Failure / Humans / Hypertension, Pulmonary - complications / Hypertension, Pulmonary - diagnostic imaging / Magnetic Resonance Imaging / Male / Medical prognosis / Morphology / Patients / Predictive Value of Tests / Prognosis / Pulmonary Arterial Hypertension / Pulmonary Arterial Hypertension - diagnostic imaging / Pulmonary hypertension / Pulmonary Vascular Disease / Regression analysis / Stroke Volume / Survival analysis / Variables / Variance analysis / Ventricular Dysfunction, Right - complications / Ventricular Dysfunction, Right - etiology / Ventricular Function, Right / Ventricular Remodeling / Work stations