Exercise cardiovascular magnetic resonance imaging allows differentiation of low-risk pulmonary arterial hypertension
Section snippets
Patient inclusion
Patients were eligible for inclusion if they had previously been diagnosed with PAH according to recent guidelines.19, 20 Renewed right heart catheterization (RHC) was not performed in this study, as it is only performed for confirmation of the diagnosis and if patients are clinically deteriorating. Inclusion criteria were age ≥18 years and cardiac sinus rhythm. Exclusion criteria were presence of magnetic implants unsuited for CMR (CMR-compatible implanted infusion pumps were allowed), PAH
Patient inclusion and characteristics
During 2016 and 2017, 24 patients were asked to participate in our study. A total of 4 patients declined participation due to very low perceived functional capacity. The remaining 20 patients were scanned every 6 months for a total of 4 times (1 patient), 3 times (8 patients), and 2 times (5 patients), or only once (6 patients), totaling 44 scans over 2 years. Thus, 14 patients received at least 1 follow-up scan. The sex distribution was typical for modern PAH demographics, with 13 women and 7
Discussion
In this study, patients with PAH receiving specific treatment and with a predominantly low-risk profile were found to have a stratified response to exercise and may be divided into patients with increasing SV during exercise and patients with decreasing SV. Decreasing SV during exercise is associated with larger resting RV volumes and WHO FC II. Thus, the larger RV fails during exercise, as it progressively dilates with a concurrent decrease in SV. The dilated RV has exhausted its potential to
Limitations
The present study was designed to assess exercise response in patients with low-risk PAH. RHC was not renewed in relation to exercise CMR measurements. Inclusion of renewed RHC could have provided insight into the exercise response according to current hemodynamic status. Assessing exercise response at a perceived effort of >13 out of 20 on the Borg RPE scale was motivated by the concept of using a simple, individually reproducible method, expected to affect stroke volume. Exercise testing
Disclosure statement
The authors have no conflicts of interest to disclose.
This work was supported by an unrestricted grant from Actelion Nordic.
The authors thank the invasive cardiologists at the Department of Cardiology for performing right heart catheterizations to establish the PAH diagnosis. Section of Biostatistics, University of Copenhagen, provided valuable help with statistical models for repeated measurements. We also thank Karin Jensen for overseeing the walking tests.
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