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

Journal of Cardiovascular Magnetic Resonance

Piotr Blaszczak¹  Remigiusz Kazimierczyk²  Bozena Sobkowicz²  Wlodzimierz J. Musial²  Karol A. Kaminski³  Lukasz A. Malek⁴  Janusz Mysliwiec⁵  Dorota Jurgilewicz⁵  Ryszard Grzywna⁶  Stephan G. Nekolla⁶  Marcin Hladunski⁷  Piotr Szumowski⁷ 

[1]Department of Cardiology, Cardinal Wyszynski’ Hospital, Lublin, Poland

[2]Department of Cardiology, Medical University of Bialystok, Białystok, Poland

[3]Department of Cardiology, Medical University of Bialystok, Białystok, Poland

[4]Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Waszyngtona 13a, 15-269, Białystok, Poland

[5]Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland

[6]Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland

[7]Department of Nuclear Medicine, Technical University Munich, Munich, Germany

[8]Laboratory of Molecular Imaging, Medical University of Bialystok, Białystok, Poland

[9]Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland

关键词: Primary pulmonary hypertension;    Cardiovascular magnetic resonance;    Positron emission tomography;    Prognosis;    Coupling;   

DOI  :  10.1186/s12968-021-00743-2

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsTwenty-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.ResultsCoupling 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).ConclusionsCoupling 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

【 授权许可】

CC BY