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Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization

AIMS: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent qua...

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Autores principales: Hedström, Erik, Bredfelt, Anna, Rådegran, Göran, Arheden, Håkan, Ostenfeld, Ellen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373895/
https://www.ncbi.nlm.nih.gov/pubmed/32372555
http://dx.doi.org/10.1002/ehf2.12720
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author Hedström, Erik
Bredfelt, Anna
Rådegran, Göran
Arheden, Håkan
Ostenfeld, Ellen
author_facet Hedström, Erik
Bredfelt, Anna
Rådegran, Göran
Arheden, Håkan
Ostenfeld, Ellen
author_sort Hedström, Erik
collection PubMed
description AIMS: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event‐free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation. METHODS AND RESULTS: Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0–4.4) and TR fraction (TR%; 1.6, 95% CI 0.8–3.3) above median. TRV and TR% correlated with right ventricular (RV) end‐diastolic (TRV r = 0.50; TR% r = 0.39) and end‐systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = −0.32; TR% r = −0.54), pulmonary artery stroke volume (TRV r = −0.32; TR% r = −0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = −0.56; TR% r = −0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r (2) = 0.38; r (2) = 0.48). CONCLUSIONS: A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.
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spelling pubmed-73738952020-07-22 Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization Hedström, Erik Bredfelt, Anna Rådegran, Göran Arheden, Håkan Ostenfeld, Ellen ESC Heart Fail Original Research Articles AIMS: Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event‐free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation. METHODS AND RESULTS: Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0–4.4) and TR fraction (TR%; 1.6, 95% CI 0.8–3.3) above median. TRV and TR% correlated with right ventricular (RV) end‐diastolic (TRV r = 0.50; TR% r = 0.39) and end‐systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = −0.32; TR% r = −0.54), pulmonary artery stroke volume (TRV r = −0.32; TR% r = −0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = −0.56; TR% r = −0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r (2) = 0.38; r (2) = 0.48). CONCLUSIONS: A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH. John Wiley and Sons Inc. 2020-05-06 /pmc/articles/PMC7373895/ /pubmed/32372555 http://dx.doi.org/10.1002/ehf2.12720 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Hedström, Erik
Bredfelt, Anna
Rådegran, Göran
Arheden, Håkan
Ostenfeld, Ellen
Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization
title Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization
title_full Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization
title_fullStr Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization
title_full_unstemmed Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization
title_short Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization
title_sort risk assessment in pah using quantitative cmr tricuspid regurgitation: relation to heart catheterization
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373895/
https://www.ncbi.nlm.nih.gov/pubmed/32372555
http://dx.doi.org/10.1002/ehf2.12720
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