CMR measures of left atrial volume index and right ventricular function have prognostic value in chronic thromboembolic pulmonary hypertension

Yousef Shahin, Samer Alabed, Syed Rehan Quadery, Robert A. Lewis, Christopher Johns, Dheyaa Alkhanfar, Maria Sukhanenko, Faisal Alandejani, Pankaj Garg, Charlie A. Elliot, Abdul Hameed, Athaniosis Charalampopoulos, James M. Wild, Robin Condliffe, Andrew J. Swift, David G. Kiely

Research output: Contribution to journalArticlepeer-review

Abstract

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) (p = 0.040), left-atrial-volume-index (LAVI) (p = 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 (p < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) (p = 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.

Original languageEnglish
Article number840196
JournalFrontiers in Medicine
Volume9
DOIs
Publication statusPublished - 14 Mar 2022

Keywords

  • cardiac MRI
  • chronic thromboembolic pulmonary hypertension
  • left atrium
  • left heart disease
  • survival

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