COMPETENCY IN MEDICAL KNOWLEDGE: In the present study, we demonstrated the prognostic value
Original ResearchPulmonary Artery Strain Predicts Prognosis in Pulmonary Arterial Hypertension
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Section snippets
Study population
In this multicenter study, data from 169 patients diagnosed with PAH following multimodal imaging assessment and right heart catheterization were retrieved from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre)6 and INITIATE (Integrated computatioNal modelIng of righT heart mechanIcs and blood flow dynAmics in congeniTal hEart disease)7 registries. The diagnostic criteria for PAH was based on guidelines1: mean pulmonary artery pressure >25 mm Hg,
Baseline demographic and clinical variables
Patient demographic, clinical, and CMR characteristics of the study population are shown in Table 1. Seventy and 90 patients had idiopathic PAH and PAH associated with connective tissue disease (CTD), respectively. Sixty-one percent (103/169) of patients were in World Health Organization functional class III-IV, and the median REVEAL 2.0 and COMPERA 2.0 were 8 and 3, respectively. Patients with PAH had significantly higher RV EDV index and ESV index and lower right ventricular ejection fraction
Discussion
Our study has demonstrated an approach for identifying patients with PAH at high risk of death using PA GLS from CMR feature tracking. This is one of the largest studies to examine PA strain and long-term outcomes in a characterized adult PAH cohort that combined 2 contemporary PAH registries. We have demonstrated that PA GLS reflects a combination of both PA stiffness and RV function. We show for the first time that impairment of PA GLS is a significant and independent predictor of mortality
Conclusions
We propose PA GLS as a noninvasive approach for identifying patients with PAH who are at high risk of death and who may benefit from intensified therapy and/or closer surveillance. Our study has demonstrated that PA GLS has significant prognostic utility over standard risk score as well as RV volume and functional indices, which supports its potential role in the clinical management of patients with PAH.
Funding Support and Author Disclosures
This study has received funding support from the National Medical Research Council of Singapore (NMRC/OFIRG/0018/2016). Dr Kiely has received personal fees for consultancy work, educational talks and participation in steering committees from Acceleron, Ferrer, GSK, MSD, and Janssen; and has received funding from the National Institute for Health and Care Research, Sheffield Biomedical Research Centre. The funder had no role in the design and conduct of the study; collection; management,
References (31)
- et al.
Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension
Chest
(2007) - et al.
RV dysfunction in pulmonary hypertension is independently related to pulmonary artery stiffness
J Am Coll Cardiol Img
(2012) - et al.
Cardiovascular magnetic resonance-assessed fast global longitudinal strain parameters add diagnostic and prognostic insights in right ventricular volume and pressure loading disease conditions
J Cardiovasc Magn Reson
(2021) - et al.
Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies
Chest
(2019) - et al.
Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging
J Cardiovasc Magn Reson
(2018) - et al.
Non-invasive measurement using cardiovascular magnetic resonance of changes in pulmonary artery stiffness with exercise
J Cardiovasc Magn Reson
(2015) - et al.
Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance
J Am Coll Cardiol Img
(2009) - et al.
Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing
J Cardiovasc Magn Reson
(2013) - et al.
Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension
J Am Coll Cardiol
(2006) - et al.
Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy
J Am Coll Cardiol
(2011)
Cardiac-MRI predicts clinical worsening and mortality in pulmonary arterial hypertension: a systematic review and meta-analysis
J Am Coll Cardiol Img
Prognostic impact of right ventricular mass change in patients with idiopathic pulmonary arterial hypertension
Int J Cardiol
2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)
Eur Heart J
Biaxial properties of the left and right pulmonary arteries in a monocrotaline rat animal model of pulmonary arterial hypertension
J Biomech Eng
Noninvasive assessment of pulmonary arterial capacitance by pulmonary annular motion velocity in children with ventricular septal defect
Cardiovasc Ultrasound
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Drs Zhong, Leng, and Alabed contributed equally to this paper.