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

Alandejani, Faisal, Hameed, Abdul, Tubman, Euan, Alabed, Samer, Shahin, Yousef, Lewis, Robert A., Dwivedi, Krit, Mahmood, Aqeeb, Middleton, Jennifer, Watson, Lisa, Alkhanfar, Dheyaa, Johns, Christopher S., Rajaram, Smitha, Garg, Pankaj ORCID:, Condliffe, Robin, Elliot, Charlie A., Thompson, A. A. Roger, Rothman, Alexander M. K., Charalampopoulos, Athanasios, Lawrie, Allan, Wild, Jim M., Swift, Andrew J. and Kiely, David G. (2022) Imaging and risk stratification in pulmonary arterial hypertension: Time to include right ventricular assessment. Frontiers in Cardiovascular Medicine, 9. ISSN 2297-055X

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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.

Item Type: Article
Additional Information: 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).
Uncontrolled Keywords: cardiac magnetic resonance imaging (cmri),pulmonary arterial hypertension (pah),pulmonary hypertension,right atrial area,right ventricular (rv),risk stratification,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 24 Oct 2022 10:30
Last Modified: 31 Oct 2022 10:30
DOI: 10.3389/fcvm.2022.797561

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