Cardiovascular magnetic resonance predicts all-cause mortality in pulmonary hypertension associated with heart failure with preserved ejection fraction

Garg, Pankaj, Lewis, Robert A., Johns, Christopher S., Swift, Andrew J., Capener, David, Rajaram, Smitha, Thompson, A. A. Roger, Condliffe, Robin, Elliot, Charlie A., Charalampopoulos, Athanasios, Hameed, Abdul G., Rothman, Alexander, Wild, Jim M. and Kiely, David G. (2021) Cardiovascular magnetic resonance predicts all-cause mortality in pulmonary hypertension associated with heart failure with preserved ejection fraction. International Journal of Cardiovascular Imaging, 37 (10). pp. 3019-3025. ISSN 1569-5794

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Abstract

This study aimed to determine the prognostic value of cardiovascular magnetic resonance (CMR) in patients with heart failure with preserved ejection fraction and associated pulmonary hypertension (pulmonary hypertension-HFpEF). Patients with pulmonary hypertension-HFpEF were recruited from the ASPIRE registry and underwent right heart catheterisation (RHC) and CMR. On RHC, the inclusion criteria was a mean pulmonary artery pressure (MPAP) ≥ 25 mmHg and pulmonary arterial wedge pressure > 15 mmHg and, on CMR, a left atrial volume > 41 ml/m 2 with left ventricular ejection fraction > 50%. Cox regression was performed to evaluate CMR against all-cause mortality. In this study, 116 patients with pulmonary hypertension-HFpEF were identified. Over a mean follow-up period of 3 ± 2 years, 61 patients with pulmonary hypertension-HFpEF died (53%). In univariate regression, 11 variables demonstrated association to mortality: indexed right ventricular (RV) volumes and stroke volume, right ventricular ejection fraction (RVEF), indexed RV mass, septal angle, pulmonary artery systolic/diastolic area and its relative area change. In multivariate regression, only three variables were independently associated with mortality: RVEF (HR 0.64, P < 0.001), indexed RV mass (HR 1.46, P < 0.001) and IV septal angle (HR 1.48, P < 0.001). Our CMR model had 0.76 area under the curve (P < 0.001) to predict mortality. This study confirms that pulmonary hypertension in patients with HFpEF is associated with a poor prognosis and we observe that CMR can risk stratify these patients and predict all-cause mortality. When patients with HFpEF develop pulmonary hypertension, CMR measures that reflect right ventricular afterload and function predict all-cause mortality.

Item Type: Article
Additional Information: Funding Information: This work was partly funded by the Wellcome Trust (205188/Z/16/Z), British Heart Foundation Grant to AART (FS/18/13/33281) and MRC Grant MR/M008894/1. Publisher Copyright: © 2021, The Author(s).
Uncontrolled Keywords: heart failure,magnetic resonance imaging,prognosis,pulmonary hypertension,right ventricular function,radiology nuclear medicine and imaging,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2741
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 13 Nov 2021 01:52
Last Modified: 19 Nov 2021 01:39
URI: https://ueaeprints.uea.ac.uk/id/eprint/82094
DOI: 10.1007/s10554-021-02279-z

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