Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure

• Published in: Arquivos brasileiros de cardiologia Vol. 106; no. 3; pp. 226 - 235
• Main Authors: Fabregat-Andrés, Óscar, Estornell-Erill, Jordi, Ridocci-Soriano, Francisco, Pérez-Boscá, José Leandro, García-González, Pilar, Payá-Serrano, Rafael, Morell, Salvador, Cortijo, Julio
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cardiologia - SBC 01-03-2016; Sociedade Brasileira de Cardiologia (SBC)
• Subjects: Aged; CARDIAC & CARDIOVASCULAR SYSTEMS; Espectroscopia de Ressonância Magnética; Female; Heart Failure, Systolic - diagnosis; Heart Failure, Systolic - mortality; Heart Failure, Systolic - physiopathology; Hipertensão Pulmonar; Humans; Insuficiência Cardíaca; Magnetic Resonance Imaging, Cine - standards; Male; Middle Aged; Original; Predictive Value of Tests; Prognosis; Prognóstico; Prospective Studies; Resistência Vascular; Stroke Volume - physiology; Survival Analysis; Vascular Resistance - physiology; Vascular Resistance; Prognosis; Magnetic Resonance Spectroscopy; Prognóstico; Insuficiência Cardíaca; Hipertensão Pulmonar; Espectroscopia de Ressonância Magnética; Heart Failure; Hypertension, Pulmonary; Resistência Vascular
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20160020

Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice.
We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF).
Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVR were calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up.
105 patients (average LVEF 26.0 ± 7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7 estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03).
In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.