Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response

Goh, Ze Ming, Balasubramanian, Nithin, Alabed, Samer, Dwivedi, Krit, Shahin, Yousef, Rothman, Alexander M. K., Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X, Lawrie, Allan, Capener, David, Thompson, A. A. Roger, Alandejani, Faisal, Wild, Jim M., Johns, Christopher S., Lewis, Robert A., Gosling, Rebecca, Sharkey, Michael, Condliffe, Robin, Kiely, David G. and Swift, Andrew J. (2022) Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response. Heart, 108 (17). pp. 1392-1400. ISSN 1355-6037

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Objectives: To determine the prognostic value of patterns of right ventricular adaptation in patients with pulmonary arterial hypertension (PAH), assessed using cardiac magnetic resonance (CMR) imaging at baseline and follow-up. Methods: Patients attending the Sheffield Pulmonary Vascular Disease Unit with suspected pulmonary hypertension were recruited into the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral Centre) Registry. With exclusion of congenital heart disease, consecutive patients with PAH were followed up until the date of census or death. Right ventricular end-systolic volume index adjusted for age and sex and ventricular mass index were used to categorise patients into four different volume/mass groups: low-volume-low-mass, low-volume-high-mass, high-volume-low-mass and high-volume-high-mass. The prognostic value of the groups was assessed with one-way analysis of variance and Kaplan-Meier plots. Transition of the groups was studied. Results: A total of 505 patients with PAH were identified, 239 (47.3%) of whom have died at follow-up (median 4.85 years, IQR 4.05). The mean age of the patients was 59±16 and 161 (32.7%) were male. Low-volume-low-mass was associated with CMR and right heart catheterisation metrics predictive of improved prognosis. There were 124 patients who underwent follow-up CMR (median 1.11 years, IQR 0.78). At both baseline and follow-up, the high-volume-low-mass group had worse prognosis than the low-volume-low-mass group (p<0.001). With PAH therapy, 73.5% of low-volume-low-mass patients remained in this group, whereas only 17.4% of high-volume-low-mass patients transitioned into low-volume-low-mass. Conclusions: Right ventricular adaptation assessed using CMR has prognostic value in patients with PAH. Patients with maladaptive remodelling (high-volume-low-mass) are at high risk of treatment failure.

Item Type: Article
Additional Information: Funding Information: The study was funded by Wellcome Trust (205188/Z/16/Z) and is supported by the MRC Imaging Infrastructure Award (MR/M008894/1).
Uncontrolled Keywords: heart failure,magnetic resonance imaging,pulmonary arterial hypertension,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 07 Sep 2022 14:30
Last Modified: 19 Oct 2023 03:24
URI: https://ueaeprints.uea.ac.uk/id/eprint/87845
DOI: 10.1136/heartjnl-2021-320733


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