Dataset Information

Increased right atrial volume measured with cardiac magnetic resonance is associated with worse clinical outcome in patients with pre-capillary pulmonary hypertension.

ABSTRACT:

Aims

Pre-capillary pulmonary hypertension (PH_pre-cap ) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). Whether cardiac magnetic resonance (CMR)-based quantification of atrial volumes in PH_pre-cap is beneficial in risk assessment is unknown. The aims were to investigate if (i) atrial volumes using CMR are associated with death or lung transplantation in PH_pre-cap , (ii) atrial volumes differ among four unmatched major PH_pre-cap subgroups, and (iii) atrial volumes differ between SSc-PAH and idiopathic/familial PAH (IPAH/FPAH) when matched for pulmonary vascular resistance (PVR).

Methods and results

Seventy-five PH_pre-cap patients (57 ± 19 years, 53 female, 43 de novo) with CMR and right heart catheterization were retrospectively included. Short-axis stacks of cine images were analysed, and right and left atrial maximum (RAV_max and LAV_max ) and minimum volume (RAV_min and LAV_min ) were indexed for body surface area. Increased (mean + 2 SD) and reduced (mean - 2 SD) volumes were predefined from CMR normal values. Transplantation-free survival was lower in patients with increased RAV_max than in those with normal [hazard ratio (HR) = 2.1, 95% confidence interval (CI) 1.1-4.0] but did not differ between those with reduced LAV_max and normal (HR 2.0, 95% CI 0.8-5.1). RAV_max and RAV_min showed no differences among unmatched or matched groups (P = ns). When matched for PVR, LAV_max , LAV_min , and pulmonary artery wedge pressure were reduced in SSc-PAH compared with IPAH/FPAH (95% CI 0.3-21.4, 95% CI 0.8-19.6, and 95% CI 2-7, respectively).

Conclusions

Patients with PH_pre-cap and increased right atrial volume measured with CMR had worse clinical outcome. When matched for PVR, left atrial volume was lower in SSc-PAH than in IPAH/FPAH, consistent with left-sided underfilling, indicating a potential differentiator between the groups.

SUBMITTER: Bredfelt A

PROVIDER: S-EPMC6165945 | biostudies-literature |

REPOSITORIES: biostudies-literature

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