Frontiers in Cardiovascular Medicine (Mar 2022)

Imaging and Risk Stratification in Pulmonary Arterial Hypertension: Time to Include Right Ventricular Assessment

  • Faisal Alandejani,
  • Abdul Hameed,
  • Abdul Hameed,
  • Euan Tubman,
  • Samer Alabed,
  • Samer Alabed,
  • Yousef Shahin,
  • Yousef Shahin,
  • Robert A. Lewis,
  • Robert A. Lewis,
  • Krit Dwivedi,
  • Aqeeb Mahmood,
  • Jennifer Middleton,
  • Jennifer Middleton,
  • Lisa Watson,
  • Dheyaa Alkhanfar,
  • Christopher S. Johns,
  • Smitha Rajaram,
  • Pankaj Garg,
  • Robin Condliffe,
  • Charlie A. Elliot,
  • A. A. Roger Thompson,
  • A. A. Roger Thompson,
  • Alexander M. K. Rothman,
  • Alexander M. K. Rothman,
  • Alexander M. K. Rothman,
  • Athanasios Charalampopoulos,
  • Allan Lawrie,
  • Jim M. Wild,
  • Jim M. Wild,
  • Andrew J. Swift,
  • Andrew J. Swift,
  • David G. Kiely,
  • David G. Kiely,
  • David G. Kiely

DOI
https://doi.org/10.3389/fcvm.2022.797561
Journal volume & issue
Vol. 9

Abstract

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BackgroundCurrent European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).MethodsConsecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.ResultsIn 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.ConclusionThis study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.

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