Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension

• Published in: Journal of cardiovascular magnetic resonance 2021-05, Vol.23 (1), p.49-49, Article 49
• Main Authors: Kazimierczyk, Remigiusz, Malek, Lukasz A, Szumowski, Piotr, Nekolla, Stephan G, Blaszczak, Piotr, Jurgilewicz, Dorota, Hladunski, Marcin, Sobkowicz, Bozena, Mysliwiec, Janusz, Grzywna, Ryszard, Musial, Wlodzimierz J, Kaminski, Karol A
• Format: Article
• Language: English
• Subjects: Blood pressure; Cardiac output; Cardiology; Cardiovascular magnetic resonance; Clinical deterioration; Coupling; Dextrose; Emission analysis; Glucose; Glucose metabolism; Heart Ventricles - diagnostic imaging; Hemodynamics; Humans; Hypertension; Hypertension, Pulmonary - diagnostic imaging; Magnetic resonance; Metabolism; Multivariate analysis; Parameters; PET imaging; Positron emission; Positron emission tomography; Predictive Value of Tests; Primary pulmonary hypertension; Prognosis; Pulmonary Arterial Hypertension; Pulmonary arteries; Pulmonary artery; Pulmonary hypertension; Software; Statistical analysis; Systolic pressure; Tomography; Veins & arteries; Ventricle; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Function, Right
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-021-00743-2

In pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients. Twenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload-pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUV . Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration. Coupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUV ). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (-)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R  = 0.68; p