The Value of Hemodynamic Measurements or Cardiac MRI in the Follow-up of Patients With Idiopathic Pulmonary Arterial Hypertension

The Value of Hemodynamic Measurements or Cardiac MRI in the Follow-up of Patients With Idiopathic Pulmonary Arterial Hypertension

Treatment of patients with pulmonary arterial hypertension (PAH) is conventionally based on functional plus invasive measurements obtained during right heart catheterization (RHC). Whether risk assessment during repeated measurements could also be performed on the basis of imaging parameters is uncl...

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Bibliographic Details
Published in:Chest Vol. 159; no. 4; pp. 1575 - 1585
Main Authors: van der Bruggen, Cathelijne Emma, Handoko, Martin Louis, Bogaard, Harm Jan, Marcus, Johannes Timotheus, Oosterveer, Franciscus Petrus Theodorus, Meijboom, Lilian Jacoba, Westerhof, Berend Eric, Vonk Noordegraaf, Anton, de Man, Frances S.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-04-2021
American College of Chest Physicians
Subjects:
imaging
Pulmonary and Cardiovascular: Original Research
pulmonary hypertension
right ventricle
mPAP
NYHA
RAP
Svo2
RVEF
RV
pulmonary hypertension
SVi
CMR
CO
RHC
imaging
PVR
ERS/ESC
PAWP
RVESV
NT-proBNP
right ventricle
PAH
RVEDV
AIC
6MWD
iPAH
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Summary:Treatment of patients with pulmonary arterial hypertension (PAH) is conventionally based on functional plus invasive measurements obtained during right heart catheterization (RHC). Whether risk assessment during repeated measurements could also be performed on the basis of imaging parameters is unclear, as a direct comparison of strategies is lacking. How does the predictive value of noninvasive parameters compare with that of invasive hemodynamic measurements 1 year after the diagnosis of idiopathic PAH? One hundred and eighteen patients with idiopathic PAH who underwent RHC and cardiac MRI (CMR) were included in this study (median time between baseline evaluation and first parameter measures, 1.0 [0.8-1.2] years). Forty-four patients died or underwent lung transplantation. Forward Cox regression analyses were done to determine the best predictive functional, hemodynamic, and/or imaging model. Patients were classified as high risk if the event occurred < 5 years after diagnosis (n = 24), whereas patients without event were classified as low risk. A prognostic model based on age, sex, and absolute values at follow-up of functional parameters (6-min walk distance) performed well (Akaike information criterion [AIC], 279; concordance, 0.67). Predictive models with only hemodynamic (right atrial pressure, mixed venous oxygen saturation; AIC, 322; concordance, 0.66) or imaging parameters (right ventricular ejection fraction; AIC, 331; concordance, 0.63) at 1 year of follow-up performed similarly. The predictive value improved when functional data were combined with either hemodynamic data (AIC, 268; concordance, 0.69) or imaging data (AIC, 273; concordance, 0.70). A model composed of functional, hemodynamic, and imaging data performed only marginally better (AIC, 266; concordance, 0.69). Finally, changes between baseline and 1-year follow-up were observed for multiple hemodynamic and CMR parameters; only a change in CMR parameters was of prognostic predictive value. At 1 year of follow-up, risk assessment based on CMR is at least equal to risk assessment based on RHC. In this study, only changes in CMR, but not hemodynamic parameters, were of prognostic predictive value during the first year of follow-up.
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ISSN:0012-3692
1931-3543
DOI:10.1016/j.chest.2020.10.077