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Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR

OBJECTIVES: The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. BACKGROUND: Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomar...

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Autores principales: Seraphim, Andreas, Knott, Kristopher D., Menacho, Katia, Augusto, Joao B., Davies, Rhodri, Pierce, Iain, Joy, George, Bhuva, Anish N., Xue, Hui, Treibel, Thomas A., Cooper, Jackie A., Petersen, Steffen E., Fontana, Marianna, Hughes, Alun D., Moon, James C., Manisty, Charlotte, Kellman, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560640/
https://www.ncbi.nlm.nih.gov/pubmed/34023269
http://dx.doi.org/10.1016/j.jcmg.2021.03.029
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author Seraphim, Andreas
Knott, Kristopher D.
Menacho, Katia
Augusto, Joao B.
Davies, Rhodri
Pierce, Iain
Joy, George
Bhuva, Anish N.
Xue, Hui
Treibel, Thomas A.
Cooper, Jackie A.
Petersen, Steffen E.
Fontana, Marianna
Hughes, Alun D.
Moon, James C.
Manisty, Charlotte
Kellman, Peter
author_facet Seraphim, Andreas
Knott, Kristopher D.
Menacho, Katia
Augusto, Joao B.
Davies, Rhodri
Pierce, Iain
Joy, George
Bhuva, Anish N.
Xue, Hui
Treibel, Thomas A.
Cooper, Jackie A.
Petersen, Steffen E.
Fontana, Marianna
Hughes, Alun D.
Moon, James C.
Manisty, Charlotte
Kellman, Peter
author_sort Seraphim, Andreas
collection PubMed
description OBJECTIVES: The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. BACKGROUND: Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomarkers of cardiopulmonary status. The development of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping permits their automated derivation, facilitating clinical adoption. METHODS: In this retrospective 2-center study of patients referred for clinical myocardial perfusion assessment using CMR, analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically (incorporating artificial intelligence techniques), allowing estimation of PTT and subsequent derivation of PBVi. Association with major adverse cardiovascular events (MACE) and all-cause mortality were evaluated using Cox proportional hazard models, after adjusting for comorbidities and CMR parameters. RESULTS: A total of 985 patients (67% men, median age 62 years [interquartile range (IQR): 52 to 71 years]) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR: 54% to 69%). PTT increased with age, male sex, atrial fibrillation, and left atrial area, and reduced with LVEF, heart rate, diabetes, and hypertension (model r(2) = 0.57). Over a median follow-up period of 28.6 months (IQR: 22.6 to 35.7 months), MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both PTT and PBVi independently predicted MACE, but not all-cause mortality. There was no association between cardiac index and MACE. For every 1 × SD (2.39-s) increase in PTT, the adjusted hazard ratio for MACE was 1.43 (95% confidence interval [CI]: 1.10 to 1.85; p = 0.007). The adjusted hazard ratio for 1 × SD (118 ml/m(2)) increase in PBVi was 1.42 (95% CI: 1.13 to 1.78; p = 0.002). CONCLUSIONS: Pulmonary transit time (and its derived parameter pulmonary blood volume index), measured automatically without user interaction as part of CMR perfusion mapping, independently predicted adverse cardiovascular outcomes. These biomarkers may offer additional insights into cardiopulmonary function beyond conventional predictors including ejection fraction.
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spelling pubmed-85606402021-11-08 Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR Seraphim, Andreas Knott, Kristopher D. Menacho, Katia Augusto, Joao B. Davies, Rhodri Pierce, Iain Joy, George Bhuva, Anish N. Xue, Hui Treibel, Thomas A. Cooper, Jackie A. Petersen, Steffen E. Fontana, Marianna Hughes, Alun D. Moon, James C. Manisty, Charlotte Kellman, Peter JACC Cardiovasc Imaging Original Research OBJECTIVES: The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. BACKGROUND: Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomarkers of cardiopulmonary status. The development of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping permits their automated derivation, facilitating clinical adoption. METHODS: In this retrospective 2-center study of patients referred for clinical myocardial perfusion assessment using CMR, analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically (incorporating artificial intelligence techniques), allowing estimation of PTT and subsequent derivation of PBVi. Association with major adverse cardiovascular events (MACE) and all-cause mortality were evaluated using Cox proportional hazard models, after adjusting for comorbidities and CMR parameters. RESULTS: A total of 985 patients (67% men, median age 62 years [interquartile range (IQR): 52 to 71 years]) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR: 54% to 69%). PTT increased with age, male sex, atrial fibrillation, and left atrial area, and reduced with LVEF, heart rate, diabetes, and hypertension (model r(2) = 0.57). Over a median follow-up period of 28.6 months (IQR: 22.6 to 35.7 months), MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both PTT and PBVi independently predicted MACE, but not all-cause mortality. There was no association between cardiac index and MACE. For every 1 × SD (2.39-s) increase in PTT, the adjusted hazard ratio for MACE was 1.43 (95% confidence interval [CI]: 1.10 to 1.85; p = 0.007). The adjusted hazard ratio for 1 × SD (118 ml/m(2)) increase in PBVi was 1.42 (95% CI: 1.13 to 1.78; p = 0.002). CONCLUSIONS: Pulmonary transit time (and its derived parameter pulmonary blood volume index), measured automatically without user interaction as part of CMR perfusion mapping, independently predicted adverse cardiovascular outcomes. These biomarkers may offer additional insights into cardiopulmonary function beyond conventional predictors including ejection fraction. Elsevier 2021-11 /pmc/articles/PMC8560640/ /pubmed/34023269 http://dx.doi.org/10.1016/j.jcmg.2021.03.029 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Research
Seraphim, Andreas
Knott, Kristopher D.
Menacho, Katia
Augusto, Joao B.
Davies, Rhodri
Pierce, Iain
Joy, George
Bhuva, Anish N.
Xue, Hui
Treibel, Thomas A.
Cooper, Jackie A.
Petersen, Steffen E.
Fontana, Marianna
Hughes, Alun D.
Moon, James C.
Manisty, Charlotte
Kellman, Peter
Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
title Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
title_full Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
title_fullStr Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
title_full_unstemmed Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
title_short Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
title_sort prognostic value of pulmonary transit time and pulmonary blood volume estimation using myocardial perfusion cmr
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560640/
https://www.ncbi.nlm.nih.gov/pubmed/34023269
http://dx.doi.org/10.1016/j.jcmg.2021.03.029
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