CMR Measures of Left Atrial Volume Index and Right Ventricular Function Have Prognostic Value in Chronic Thromboembolic Pulmonary Hypertension

Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magneti...

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Published in:	Frontiers in medicine Vol. 9; p. 840196
Main Authors:	Shahin, Yousef, Alabed, Samer, Rehan Quadery, Syed, Lewis, Robert A, Johns, Christopher, Alkhanfar, Dheyaa, Sukhanenko, Maria, Alandejani, Faisal, Garg, Pankaj, Elliot, Charlie A, Hameed, Abdul, Charalampopoulos, Athaniosis, Wild, James M, Condliffe, Robin, Swift, Andrew J, Kiely, David G
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 14-03-2022
Subjects:	cardiac MRI chronic thromboembolic pulmonary hypertension left atrium left heart disease Medicine survival chronic thromboembolic pulmonary hypertension left heart disease cardiac MRI left atrium survival
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Summary:	Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magnetic resonance imaging (CMR) in CTEPH. Consecutive treatment-naive patients with CTEPH who underwent right heart catheterization and CMR between 2011 and 2017 were identified from the ASPIRE (Assessing-the-Specturm-of-Pulmonary-hypertensIon-at-a-REferral-center) registry. CMR metrics were corrected for age and sex where appropriate. Univariate and multivariate regression models were generated to assess the prognostic ability of CMR metrics in CTEPH. Three hundred and seventy-five patients (mean+/-standard deviation: age 64+/-14 years, 49% female) were identified and 181 (48%) had pulmonary endarterectomy (PEA). For all patients with CTEPH, left-ventricular-stroke-volume-index-%predicted (LVSVI%predicted) ( = 0.040), left-atrial-volume-index (LAVI) ( = 0.030), the presence of comorbidities, incremental shuttle walking test distance (ISWD), mixed venous oxygen saturation and undergoing PEA were independent predictors of mortality at multivariate analysis. In patients undergoing PEA, LAVI ( < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) ( = 0.040), age and ISWD were independent predictors of mortality. CMR metrics reflecting cardiac function and left heart disease have prognostic value in CTEPH. In those undergoing PEA, LAVI predicts outcome whereas in patients not undergoing PEA RVEF%pred predicts outcome. This study highlights the prognostic value of imaging cardiac structure and function in CTEPH and the importance of considering left heart disease in patients considered for PEA.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Elena Goncharova, University of California, Davis, United States This article was submitted to Pulmonary Medicine, a section of the journal Frontiers in Medicine Reviewed by: Roberto J. Bernardo, University of Oklahoma Health Sciences Center, United States; Mark O. Wielpütz, Heidelberg University, Germany
ISSN:	2296-858X 2296-858X
DOI:	10.3389/fmed.2022.840196