Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment

Faisal Alandejani; Abdul Hameed; Euan Tubman; Samer Alabed; Yousef Shahin; Robert A. Lewis; Krit Dwivedi; Aqeeb Mahmood; Jennifer Middleton; Lisa Watson; Dheyaa Alkhanfar; Christopher S. Johns; Smitha Rajaram; Pankaj Garg; Robin Condliffe; Charlie A. Elliot; A. A. Roger Thompson; Alexander M. K. Rothman; Athanasios Charalampopoulos; Allan Lawrie; Jim M. Wild; Andrew J. Swift; David G. Kiely

doi:10.3389/fcvm.2022.797561

Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment

Faisal Alandejani, Abdul Hameed, Euan Tubman, Samer Alabed, Yousef Shahin, Robert A. Lewis, Krit Dwivedi, Aqeeb Mahmood, Jennifer Middleton, Lisa Watson, Dheyaa Alkhanfar, Christopher S. Johns, Smitha Rajaram, Pankaj Garg, Robin Condliffe, Charlie A. Elliot, A. A. Roger Thompson, Alexander M. K. Rothman, Athanasios Charalampopoulos, Allan LawrieJim M. Wild, Andrew J. Swift, David G. Kiely

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Abstract

Background: Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).

Methods: Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.

Results: In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.

Conclusion: This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.

Original language	English
Article number	797561
Journal	Frontiers in Cardiovascular Medicine
Volume	9
DOIs	https://doi.org/10.3389/fcvm.2022.797561
Publication status	Published - 25 Mar 2022

Keywords

cardiac magnetic resonance imaging (cMRI)
pulmonary arterial hypertension (PAH)
pulmonary hypertension
right atrial area
right ventricular (RV)
risk stratification

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Alandejani, F., Hameed, A., Tubman, E., Alabed, S., Shahin, Y., Lewis, R. A., Dwivedi, K., Mahmood, A., Middleton, J., Watson, L., Alkhanfar, D., Johns, C. S., Rajaram, S., Garg, P., Condliffe, R., Elliot, C. A., Thompson, A. A. R., Rothman, A. M. K., Charalampopoulos, A., ... Kiely, D. G. (2022). Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment. Frontiers in Cardiovascular Medicine, 9, [797561]. https://doi.org/10.3389/fcvm.2022.797561

@article{ad88a80004fd4342a34de0d0975c44a8,

title = "Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment",

abstract = "Background: Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).Methods: Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.Results: In 311 consecutive, treatment-na{\"i}ve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.Conclusion: This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.",

keywords = "cardiac magnetic resonance imaging (cMRI), pulmonary arterial hypertension (PAH), pulmonary hypertension, right atrial area, right ventricular (RV), risk stratification",

author = "Faisal Alandejani and Abdul Hameed and Euan Tubman and Samer Alabed and Yousef Shahin and Lewis, {Robert A.} and Krit Dwivedi and Aqeeb Mahmood and Jennifer Middleton and Lisa Watson and Dheyaa Alkhanfar and Johns, {Christopher S.} and Smitha Rajaram and Pankaj Garg and Robin Condliffe and Elliot, {Charlie A.} and Thompson, {A. A. Roger} and Rothman, {Alexander M. K.} and Athanasios Charalampopoulos and Allan Lawrie and Wild, {Jim M.} and Swift, {Andrew J.} and Kiely, {David G.}",

note = "Funding Information: This work was supported by Wellcome (215799/Z/19/Z and 205188/Z/16/Z). AART was supported by a British Heart Foundation Intermediate Clinical Fellowship (FS/18/13/3328).",

year = "2022",

month = mar,

day = "25",

doi = "10.3389/fcvm.2022.797561",

language = "English",

volume = "9",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media S.A.",

}

Alandejani, F, Hameed, A, Tubman, E, Alabed, S, Shahin, Y, Lewis, RA, Dwivedi, K, Mahmood, A, Middleton, J, Watson, L, Alkhanfar, D, Johns, CS, Rajaram, S, Garg, P, Condliffe, R, Elliot, CA, Thompson, AAR, Rothman, AMK, Charalampopoulos, A, Lawrie, A, Wild, JM, Swift, AJ & Kiely, DG 2022, 'Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment', Frontiers in Cardiovascular Medicine, vol. 9, 797561. https://doi.org/10.3389/fcvm.2022.797561

TY - JOUR

T1 - Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment

AU - Alandejani, Faisal

AU - Hameed, Abdul

AU - Tubman, Euan

AU - Alabed, Samer

AU - Shahin, Yousef

AU - Lewis, Robert A.

AU - Dwivedi, Krit

AU - Mahmood, Aqeeb

AU - Middleton, Jennifer

AU - Watson, Lisa

AU - Alkhanfar, Dheyaa

AU - Johns, Christopher S.

AU - Rajaram, Smitha

AU - Garg, Pankaj

AU - Condliffe, Robin

AU - Elliot, Charlie A.

AU - Thompson, A. A. Roger

AU - Rothman, Alexander M. K.

AU - Charalampopoulos, Athanasios

AU - Lawrie, Allan

AU - Wild, Jim M.

AU - Swift, Andrew J.

AU - Kiely, David G.

N1 - Funding Information: This work was supported by Wellcome (215799/Z/19/Z and 205188/Z/16/Z). AART was supported by a British Heart Foundation Intermediate Clinical Fellowship (FS/18/13/3328).

PY - 2022/3/25

Y1 - 2022/3/25

N2 - Background: Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).Methods: Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.Results: In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.Conclusion: This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.

AB - Background: Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality).Methods: Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan–Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed.Results: In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality.Conclusion: This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.

KW - cardiac magnetic resonance imaging (cMRI)

KW - pulmonary arterial hypertension (PAH)

KW - pulmonary hypertension

KW - right atrial area

KW - right ventricular (RV)

KW - risk stratification

UR - http://www.scopus.com/inward/record.url?scp=85138540262&partnerID=8YFLogxK

U2 - 10.3389/fcvm.2022.797561

DO - 10.3389/fcvm.2022.797561

M3 - Article

VL - 9

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

SN - 2297-055X

M1 - 797561

ER -

Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment

Abstract

Keywords

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