Pulmonary artery to aorta ratio for the detection of pulmonary hypertension: cardiovascular magnetic resonance and invasive hemodynamics in heart failure with preserved ejection fraction

Journal of Cardiovascular Magnetic Resonance

Research

Gültekin Karakus¹  Aleks Degirmencioglu¹  Julia Mascherbauer²  Andreas A. Kammerlander²  Diana Bonderman²  Jamil Babayev²  Stefan Aschauer²  Caroline Zotter-Tufaro²  Stefan Pfaffenberger²  Franz Duca²  Alina Bachmann²  Beatrice A. Marzluf³ 

[1] Acibadem Maslak Hospital, Istanbul, Turkey;Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria;Otto Wagner Hospital, Vienna, Austria;

关键词: Cardiovascular magnetic resonance;    Pulmonary hypertension;    PA:Ao ratio;   

DOI  :  10.1186/s12968-015-0184-3

 received in 2015-03-19, accepted in 2015-08-16,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPrevious work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown.In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF.Methods and Results159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation.By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) ≥30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 ± 5.1 mm versus 26 ± 5.1 mm, p < 0.001), PA:Ao ratio (0.93 ± 0.16 versus 0.78 ± 0.14, p < 0.001), and SMT diameter (4.6 ± 1.5 mm versus 3.8 ± 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p < 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83.Patients were followed for 22.0 ± 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio ≥0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003).ConclusionPA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.

【 授权许可】

CC BY   
© Karakus et al. 2015