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Indication of the prognosis of pulmonary hypertension by using CMR function parameters

  • Cardiac
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Abstract

Objective

This study aimed to compare the cardiac function among different sub-types of pulmonary hypertension (PH) and to explore the independent predictors of major adverse cardiovascular events (MACE).

Methods

Eighty-seven PH patients diagnosed by right heart catheterization (RHC) were recruited. Patients underwent cardiac magnetic resonance (CMR) and RHC examination within 2 weeks. The CMR images were analyzed to calculate the cardiac functional parameters including right ventricle (RV) and left ventricle (LV) end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), and myocardial mass (MM). The median follow-up time was 46.5 months (interquartile range: 26–65.5 months), and the endpoints were the occurrence of MACE.

Results

RVEDVI, LVEDVI, and LVESVI were higher in congenital heart disease–related PH (CHD-PH) than in other sub-types (p < 0.05). RVMM, RVSVI, and RVCI were highest in CHD-PH. There was no significant difference in the prognosis among different sub-types (p > 0.05). Comparing with the non-MACE group, RVEF, TAPSE, and LVSVI significantly decreased in the MACE group, while the RVESVI significantly increased (p < 0.05). TAPSE ≤ 15.65 mm and LVSVI ≤ 30.27 mL/m2 were significant independent predictors of prognosis in PH patients.

Conclusion

CHD-PH had a higher RV function reserve but lowest LVEF comparing to other subgroups. TAPSE and LVSVI could contribute to the prediction of MACE in PH patients.

Key Points

• CMR imaging is a noninvasive and accurate tool to assess ventricular function.

• CHD-PH had higher RV function reserve but lowest LVEF.

• TAPSE and LVSVI could contribute to the prediction of MACE in PH patients.

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Abbreviations

BPA:

Balloon pulmonary angioplasty

BSA:

Body surface area

CHD:

Congenital heart disease

CI:

Cardiac index

CMR:

Cardiac magnetic resonance

CO:

Cardiac output

CTD:

Connective tissue disease

CTEPH:

Chronic thromboembolic pulmonary hypertension

dPAP:

Diastolic pulmonary arterial pressure

ECG:

Electrocardiogram

EDV:

End-diastolic volume

EDVI:

End-diastolic volume index

EF:

Ejection fraction

ESV:

End-systolic volume

ESVI:

End-systolic volume index

FIESTA:

Fast imaging employing steady-state acquisition

IPAH:

Idiopathic pulmonary arterial hypertension

IVS:

Interventricular septum

LV:

Left ventricle

LVSB:

Leftward ventricular septal bowing

MACE:

Major adverse cardiovascular events

MM:

Myocardial mass

MMI:

Myocardial mass index

MPA:

Main pulmonary artery

mPAP:

Mean pulmonary arterial pressure

MRI:

Magnetic resonance imaging

PAH:

Pulmonary arterial hypertension

PAP:

Pulmonary arterial pressure

PEA:

Pulmonary endarterectomy

PH:

Pulmonary hypertension

PVR:

Pulmonary vascular resistance

RCI:

Right cardiac index

RHC:

Right heart catheterization

ROC:

Receiver operating characteristic

RV:

Right ventricle

sPAP:

Systolic pulmonary arterial pressure

SV:

Stroke volume

SVI:

Stroke volume index

TAPSE:

Tricuspid annular plane systolic excursion

TTE:

Transthoracic echocardiography

WHO:

World Health Organization

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Funding

This study has received funding from the National Natural Science Youth Science Fund Project Foundation of China (81301217), Tianjin Key Project of Applied Basic and Frontier Technology Research Program (14JCZDJC57000), and “13th Fiver-Year Plan” National key R&D projects (2016YFC1300402).

Author information

Author notes

  1. Wen Ren and Jing-Jing Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Suzhou, 215008, Jiangsu, China

    Wen Ren

  2. Department of Radiology, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China

    Wen Ren, Fan Yang, Tie-Lian Yu, Yuan-Lin Deng, Zhang Zhang & Dong Li

  3. Department of Radiology, Tianjin Huanhu Hospital, 6 Jizhao Road, Tianjin, 300350, China

    Jing-Jing Guo

  4. Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China

    Zhen-Wen Yang

Authors
  1. Wen Ren
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Corresponding authors

Correspondence to Zhang Zhang or Dong Li.

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The scientific guarantor of this publication is Dong Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Ren, W., Guo, JJ., Yang, F. et al. Indication of the prognosis of pulmonary hypertension by using CMR function parameters. Eur Radiol 31, 7121–7131 (2021). https://doi.org/10.1007/s00330-021-07835-8

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  • DOI: https://doi.org/10.1007/s00330-021-07835-8

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